Order Form

Instructions

1. Type your name & shipping address in the space provided

2. Fill in the title of each item ordered with quantity, pricing information and total

3. Click on method of payment

4. Fill in credit card information if applicable

5. Print this page and mail with payment or credit card orders may elect to order by clicking on the "Submit" button at bottom of page.

Order Form

Mail To:
H. SCOTT GRAMMER
827 Byrd Road S.E.

Hartselle, Alabama 35640

256-773-4584

Extra Instruction:

Print Title	Quantity	Price	Total Price







1-800-790-4584 Pay By: Check Money Order Master Card Visa
Alabama Residents add Tax 8% Sales Tax: Shipping and Handling: Your total price is: Card Holder: Credit Card Number: 'One Number per Box Please' Expiration date: Authorized Signature:

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