Name:_______________________________________________
Address:_____________________________________________
____________________________________________________
____________________________________________________
Zip
Code__________________
Date:________________________________________________
Quantity
Item Description
Price
Total
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Subtotal: ______________________
Shipping:______________________
Shipping is $3.50 for 1 item
$7.00 for 2 or more
items
Total Enclosed: _________________
Please make checks or
money orders out to:
Kelly Midkiff
406 4. 8th
Holden, MO 64040
Thank You!