ORDER FORM
Name _________________________________________________________ Street Address ___________________________________________________ Addt’l Address ___________________________________________________ City ________________________State_________Zip ___________________ Phone (____) ________________ Email _________________________________________________________
Name _________________________________________________________ Street Address ___________________________________________________ Addt’l Address ___________________________________________________ City ________________________State_________Zip ___________________
Code Description/Title Quant/Term Price Total
_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Subtotal
(To Vermont add 6% sales tax; To Canada add 5% or 13% GST, as required) Tax (see opposite) Shipping Total*
$ ____________ $ ____________ $ ____________ $ ____________
*PayPal payments to:
orders@russianlife.com For fastest service, call TOLL FREE: 1-800-639-4301 or visit
www.russianlife.com
q Check or Money Order q Mastercard q Visa
Card account number ___________
Exp. Date
Amount Enclosed: $ ____________ q American Express q Discover
*Payment must be made in U.S. dollars
_________________________________________________ Customer Signature
PLEASE DETACH ORDER FORM AND RETURN WITH PAYMENT IN ENVELOPE
PAYMENT
OR GIFT RECIPIENT
SHIP TO
OR GIFT GIVER
BILL TO
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20