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CHILEDOUGS

Printable Order Form

To purchase , print and fill out the following information, make check or money order payable to : CHILEDOUG'S, At this time we ar unable to accept credit cards:

Please Circle One : Master Card ----------Visa ----------Discover

Card Number___________________________________

Exp Date__________

Name on Card :_____________________________

Variety : ______________________________Size_________ Qty_________Price__________

Subtotal : _____________

Shipping (see chart below) : __________

Total : _______________

Shipping rates :

$1.00 - $12.00 = add $3.50

$13.00 - 24.00 = add $4.50

$25.00 - 32.00 = add $5.50

$33.00 and up = add $7.50

Please Send my order to :

Name:_______________________________________________

Address:____________________________________________

City : _________________________State : ______Zip:_____________

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