Order Form
McIntosh Samplers
5135 Bowdle Rd.
Harrod, OH 45850
United States (USA)
Phone/Fax: 419-648-6133
Toll Free: 800-648-6133
ekerch@wcoil.com
UPS Mailing Address (if different
Sold To: from regular mailing address):
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Daytime Phone(___)__________
Evening Phone(___)__________
Method of Payment:
[ ] Check or Money Order [ ] MasterCard [ ] VISA
Account Number [ ][ ][ ][ ]-[ ][ ][ ][ ]-[ ][ ][ ][ ]-[ ][ ][ ][ ]
Expiration Date [ ][ ]/[ ][ ]
Signature of Cardholder ____________________________
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| | |Fabric |Other | | |
|Quan |Description |Color* |Info* |Price |Total |
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*only where requested Total Merchandise| |
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Postage & Handling| |
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Sub Total| |
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Ohio Residents Add 6% Sales Tax| |
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Total| |
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