Bushpilot Shop Mail Order Form

BUSHPILOT SHOP

For those customers who wish to order the old-fashioned way, by sending a check or money order or credit card sale via snail mail, just print this page, fill it out, enclose payment, and drop it in the mail.
Please allow 4-6 weeks for delivery.
PRINT THIS FORM AND MAIL WITH PAYMENT

Send Orders To:
BUSHPILOT P.O. Box 211296 Bedford, TX 76095-8296

PAYMENT INFORMATION:

Please print this order blank, fill it out to place your orders.
And then snail mail it to us.
PLEASE PRINT CLEARLY SHIPPING ADDRESS: (If different)
Name: __________________________ Name: ___________________________

Address: __________________________ Address:___________________________

__________________________ ____________________________

City: __________________________ City: ____________________________

State:_____ ZIP: ___________ State:_____ ZIP: __________________

Country:__________________________ Country:__________________________

Daytime phone: ____/____-___________ Daytime phone: ____/____-___________

Evening Phone: ____/____-___________ Evening Phone: ____/____-___________

Payment Method (check one): _____ Money Order _____ Check _____ Credit Card

(note: we can not ship your order until we receive payment)

Optional Information About Yourself

Your Email Address:_______________________________________________

Your Fax: _______________________________________________

How you heard about us: ___________________________________________

ITEM INFORMATION:

_______ _______ _____________ ____ _______ ___________ ____________

SUBTOTAL: _____________

SHIPPING (Add 10% of Subtotal): _____________

TAX (Texas customers only) 8 1/4% _____________

International (International customers add another 10% of Subtotal) : _____________

MAKE CHECKS OUT TO: BUSHPILOT TOTAL: _____________

           ALL CREDIT CARD INFORMATION REQUIRED FOR PROCESSING
         Please check one
           o               o              o               o

Card Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Expires:_____________________

Signature: (Required) ___________________________________

Texas residents must add 81/4% tax. International customers must add an additional 10% for international shipping. All orders will be shipped via U.S. Mail or UPS ground unless otherwise requested. Actual shipping charges will be added.(The shipping charge is equal to 10% of your subtotal, 20% of your subtotal for international orders).

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