Please print this order form and fax it to 520-577-1456, or
mail to Canyon Country Originals, LLC, 6030 East Fangio Place, Tucson, AZ 85750.
Date: ___________________
Name: ______________________________________________________
Telephone Number: (please *mark* the number where you prefer to be contacted)
Evening ______________________________ Daytime ______________________________
Email: ______________________________________Address on Credit Card: _______________________________________________________
___________________________________________________________________________
___________________________________________________________________________Address for Shipping : _________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Items Ordered: Item #_______________ $_______________ Description____________________ Item #_______________ $_______________ Description____________________ Subtotal $_______________ (Subtract 5% for payment by check or MO) ($______________) AZ residents add 6.1% sales tax $_______________ Packing/Shipping @ $15/pkg* $_______________ Total in U.S. Dollars $_______________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit Card Number: __________________________________________________________
Thank you for your business!
Expiration Date: ______________________
Your name as it reads on your credit card: _________________________________________
V-Code on VISA and MasterCard, C-ID on AmEx: _________________ (V-Code is three numbers in the signature block, following last four digits of VISA & MasterCard numbers. C-ID is four numbers printed on front of AmEx card, above and to the right of card numbers.
©1998 - 2009 CCO *International shipments quoted individually. In general, they will be more than US.
