Order & Payment Form or Call wendy to process credit card purchases 541-482-3431
New Order Information
Order #1	Order #6
Order #2	Order #7
Order #3	Order #8
Order #4	Order #9
Order #5	Order #10
Amount of Payment
Description
	Plus Shipping and handling.
Amount	(Include decimal point and 2 digits for cents)
Payment Method	----Select Method----VisaMasterCardAmerican Express
Credit Card Information
Card Number	(No spaces or hyphens please)
Exp. Date	mmyy or mm/yy
Customer Information
Last Name
First Name
Address
City
State
Zip
Country	USA OTHER Argentina Australia Austria Belgium Bermuda Brazil Canada Chile China Colombia Czech Republic Denmark Fiji Finland France Germany Greece Guatemala Honduras Hong Kong Iceland India Ireland Israel Italy Japan Luxembourg Mexico Netherlands New Zealand Nicaragua North Korea Norway Paraguay Peru Phillipines Poland Portugal South Africa South Korea Spain Sweden Switzerland Taiwan Thailand Turkey UK Uruguay Venezuela
Phone
Fax
Email