TRANS-MISSISSIPPI DEPOT COMPANY
Print Order Form
Print this page of the web site and mail in to place your order
Or Email or Call To place your Order!
209 W. SPUR DR., COTTONWOOD, AZ, 86326-5003
PHONE: (928) 649-1395
(7:00 AM to 7:00 PM M-F, Mountain Time)
drsmith4895@earthlink.net
Please fill this box out clearly. It will be used as the shipping label to send your order to you
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Sold To:
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Ship To:
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Name:_________________________________
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Name:_________________________________
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Address:_______________________________
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Address:_______________________________
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City:__________________________________
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City:__________________________________
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State: _______________Zip:_______________
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State:_______________Zip:_______________
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Country:_______________________________
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Country:_______________________________
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e-mail:_________________________________
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e-mail:_________________________________
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QUANTITY
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ITEM DESCRIPTION
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PRICE
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TOTAL
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Arizona Residents please add
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8.55 %
Sales Tax
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Please See Terms and Condition Page.
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SUBTOTAL
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With orders up to $69.00, add $8.00; from $70.00 to $149.00, add $12.00; from $150.00 to $300.00, add $16.00; from $300.00 to $500.00, add $20.00; in excess of $500.00, add $30.00.
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SHIPPING &
INSURANCE
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TOTAL
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Please indicate: Check: ______ Money Order: ______
VISA or MC#: ________-_________-_________-________ Expiration: _________
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