Kountry Lights Candles Order Form

This form is for mail or fax orders only. (See bottom of form for fax number or mailing address)
Customer Information:

Customer Name:
Store Name:
Address:
City: State: Zip: Telephone:
Fax:
E-mail:
TAX ID#:

Product Order Form:
QTYSZPRODUCT DESCRIPTIONSCENTITEM#PRICE EA.TOTAL
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(If you need more space , please add to a blank sheet of paper)              Subtotal:

    Shipping is as follows:                                                                     Shipping:
    East of the Missisippi, please add 15% of your total
    West of the Missisippi, please add 20% of your total.
    We will refund any overages in shipping when the order is shipped.

                                                                                                                   Total:

Method of payment

We accept credit cards or money orders. U.S. ONLY!
$75.00 Minimum Order.

Payment Options:
Pay by Money Order
Pay by Credit Card(Please put your CC info below)

ONCE FORM COMPLETED HIT YOUR PRINT BUTTON AND EITHER FAX TO : 1-813-780-8571
OR MAIL FORM W/MONEY ORDER TO THE ADDRESS BELOW:

Kountry Lights Candles
3312 Apfel Rd
Zephyrhills, FL 33543

E-mail: Kountrylights@aol.com


Thanks for shopping with us!!
Any ?'s please feel free to call us at: 813-778-6340.

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