Eagle Wings Order Form

Phil Wiebe

P O Box 82

Elma, WA 98541

Phone: (360) 470-3842

 

QTY

Order Item Description

Price Each

Price Total

$

$

$

$

$

$

$

$

$

$

Subtotal

$

(4.95 for Win into Rev; 3.95 for Discover; or 5.95 for both in the same order) Shipping

$

Make Checks out to Phil Wiebe

$

TOTAL

$

 

Ordered By and Shipping Information

ORDERED BY:

 

SHIP TO:
(Not required if same as Ordered By)

Name:

 

Name:

Address:

 

Address:

City:

 

City:

State:

 

State:

Province:

 

Province:

Country:

 

Country:

Zip/Post Code:

-

 

Zip/Post Code:

-

Phone No.:

- -

 

Phone No.:

- -

Email Address:

 [Return]