Please Print Both Pages
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Order Form Name _____________________________________________ Phone Number ______________________________ Address ___________________________________________ E-mail Address ______________________________ City ______________________________________________ State / Province ________ Postal Code ___________ Country (if other than US) _____________________________ Order Date _________________________________ |
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Print two copies and keep one copy for your records with the name of the bank, account name, check number, and amount;
or the money order name/type and/or place of purchase, number and amount.
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Add Charges Here |
Amount |
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Surcharges (if applicable) |
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Shipping: Books, CD's or Indicators1-5 items add $5.00; 6-10 items add $10.00; 11-20 items add $15.00 |
Shipping Charges |
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Total Amount Due |
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Office Use Only Date Received _____________________________________ |
Allow 4-8 weeks for delivery Send Check or Money Order (no Credit Cards please) payable to T.R. Michels to: |
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Date Shipped _____________________________________ |
T.R. Michels Trinity Mountain Outdoors 3249 Upper 71st Street Inver Grove Heights, MN 55076 |
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Back Order _______________________________________ |
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Packed By ________________________________________ |
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