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

$

(4.00 for Win into Rev; 3.00 for Discover; or 7.00 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:

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State:

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Province:

Country:

 

Country:

Zip/Post Code:

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