Market Place

SUPPLIES ORDER FORM

 

 

 

ITEM

DESCRIPTION

PRICE

Qty.

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBTOTAL

 

Add California Sales Tx 7.75%

 

Add Shipping & Handling

 

TOTAL

 
Mail Order Form with Check:          Made out to Supreme Emblem Club
To: Viola “Gene” Dana
               1623 South Orange Ave
             West Covina, CA 91790-4442
             (626) 962-3153  Email: vgdana@yahoo.com

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