PEARL SCISSORS
BUCKLES UNLIMITED
2240 COOLIDGE HIGHWAY      BERKLEY, MICH   48072
(248) 545-6885                                 FAX (248)  546-3770 
SPEICAL ORDER FORM
FOR PAYMENT INFORMATION

TO ORDER, PRINT OUT THIS PAGE, FROM YOUR BROWSER,   7H
FILL IN THE REQUESTED INFORMATION AND MAIL OR FAX TO ABOVE ADDRESS.

Order date . .
NAME .
ADDRESS .
ADDRESS 2 .
CITY . STATE
Z IP . TEMPLE/ NAME/CITY
.
DAY PHONE . FAX PHONE
E-MAIL ADDRESS

ORDER FOR________ POCKET BADGE  _______ AUTO EMBLEM PLATE

SHIPPING CHARGES
P030VISA.gif (9422 bytes) P030MASTER.gif (8355 bytes)

For Wholesale or Custom Made Orders,click here
If you use  Credit Card for Payment. .
ON SALES OF $25.00 OR MORE

  I HAVE ENCLOSED A CHECK IN THE AMOUNT OF

 $

  (Please made checks payable to BUCKLES UNLIMITED)
OR

CHARGE MY CREDIT CARD  (see above)
ONLY OF SALES OF $25.00 OR MORE (retail)

MasterCard

VISA CARD

 CIRCLE  ONE
ACCOUNT NO.   EXP. DATE .
SIGNATURE OF CARD HOLDER

Thank You For Your Order.  If You Just Can Not Wait-----You Can e-mail Us Your Order Go To  e-mail   or Fax it,   SHIPPING CHARGES.  

 

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