LaQuay's Custom Metalwork Designs
Mail / Email Order Form
Ship To:
First Name:
Last Name:
Email Address:
Phone Number:
Fax Number:
Company:
Address:
City:
State/Province:
Other State/Province:
Zip/Postal Code:
Country:
Bill To (If Different):
First Name:
Last Name:
Email Address:
Phone Number:
Fax Number:
Company:
Address:
City:
State/Province:
Other State/Province:
Zip/Postal Code:
Country:
Quantity Description of Item Price Total
Subtotal:
Ohio Residents add 7% Sales Tax:
U.S. Residents add 10% for Shipping & Handling (for Overseas S&H charges click HERE)
C.O.D. or other fees (see "Ordering Information" for amount):
Grand Total:
Please make sure the information on the order form is correct and complete.
Be sure to include your correct phone number, address and payment information.

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