Clearwater Hat Company Order Form - fax (870)746-4294

HC 73 Box 646, Newnata, AR 72680 Phone: (870) 746-4324 e-mail "burton@mvtel.net"

STYLE COLOR MEASURE/SIZE PRICE
      Long or X-long oval? $
COMMENTS:
      Long or X-long oval? $
COMMENTS  
office use office use subtotal $
PD LS AR Residents add 6.625% $
BK XTS Shipping and handling $ 10.00
SP   Total $

METHOD OF PAYMENT: _______MC/VISA _______Check number_______Money Order

MasterCard/Visa Number - Expiration Date___________ Signature___________________________

        --         --         --        

Name___________________________________ Daytime phone______________________

Shipping Address_______________________________City____________________________State__________Zip____________

Mailing address_________________________________City___________________________State__________Zip____________

Date________________E-mail_____________________________________Fax_________________________

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All original material Copyright©1998 Clearwater Hat Company