 |
Yes, I'd like to receive information and special offers via e-mail. I understand that my e-mail address will remain confidential and never sold or given to another source. |
|
No thanks, I get enough e-mail. |
Circle H Boot and Western Store
Rt.51 North
Wapella, IL 61777
217-935-6286
Print this form and fill in the blanks then fax it to 217-935-3305 , or
mail it to the address above.
We will contact you in 24 to 48 hours after receipt to confirm the order, specify pricing
and shipping information, and answer any questions you may have.
| Customer info: | Ship To: | (If different from your own) | ||
| Name: | _________________________ | Name: | _________________________ | |
| Address: | _________________________ | Address: | _________________________ | |
| _________________________ | _________________________ | |||
| City: | _________________________ | City: | _________________________ | |
| State: | _________________________ | State: | _________________________ | |
| Zip: | _________________________ | Zip: | _________________________ | |
| Phone #: | _____ ______ ________ | Phone #: | _____ ______ ________ | |
| E-Mail*: | _________________________ | E-Mail*: | _________________________ | |
| Signature: | _________________________ |
* = Optional
|
Yes, I'd like to receive information and special offers via e-mail. I understand that my e-mail address will remain confidential and never sold or given to another source. |
|
No thanks, I get enough e-mail. |
Today's Date is: ___________________________
| Quantity | Description (style, size, color, etc.) | Pricing* |
* Prior to processing the order, you will be contacted with pricing information such as
shipping, tax etc.