MAIL/FAX ORDER FORM

To order:

(1) Print out this form.

(2) Fill in your order information and address.

(3) Mail this form to Robert Fultz, 673 Old Stage Road, East Brunswick, NJ 08816

OR fax this form to us at (732) 251-3498

Phone orders may be placed at (732) 251-3498

These prices are in effect as of January 1, 2006.

  Quantity    

Type Price Color (circle one)

     Total      

. Flat Redwood $89/1000 lids

Silver    Gold

.
. Flat Silver Creek $89/1000 lids

Silver    Gold

.
. Flat Indian Time $89/1000 lids

Silver    Gold

.
. Rolled Redwood $139/1000 cones

Silver    Gold

.
. Rolled Silver Creek $139/1000 cones

Silver    Gold

.
. Rolled Indian Time $139/1000 cones

Silver    Gold

.
. Flat Kid Lids $85/1000 lids

Silver    Gold

.
. Rolled Kid Lids $139/1000 cones

Silver    Gold

.
. Metal Cone Roller $20 each . .
. . Add $9.00 for COD . .
. . TOTAL . .

FREE UPS GROUND SHIPPING on orders of 1000 or more in the continental US

We are currently unable to ship outside of the continental US

For prices for quantities under 1000, click here.

MONEY ORDERS ONLY-NO PERSONAL CHECKS

NAME __________________________________________        ___  Check here if you are a new customer.

ADDRESS _______________________________________

CITY ____________________ STATE _____ ZIP _______ PHONE (       ) _____-____________