Mail-In Order Form

Print this form, fill it out clearly, and mail it with your check or money order. Include contact info and full shipping address.

Name:
____________________________
Phone:
____________________________

Shipping Address:
____________________________
____________________________

Order Details

(Include product name and any machine/model details)

____________________________
____________________________
____________________________

Quantity:
__________
Subtotal:
__________
MI Sales Tax:
__________
Other State Tax (if applicable):
__________

Total Amount (USD): __________________________

If your state requires sales tax, please include it in your total.

Tax Exempt

Tax ID / SS#: __________________________

Payment

☐ Check    ☐ Money Order
Payable to: Kurt Snider

Mail To:
Kurt Snider, PO Box 496, Harrison, MI 48625

Signature:
____________________________
Date:
____________________________