ORDER FORM
Klotz Country Crafts
Home of the Card Weaver's Surf-Board
908 E. Eloika Rd.
Deer Park, WA
99006-7107
This form CAN NOT be sent over the Internet.
You may fill it out on screen, (do not switch to another screen or your entries will be cleared).
When filled out, turn your printer on and use your browsers print command to print the form.
OR you may print the form out as a blank then fill it in with a pen. Please print LEGIBLY.
Customer's Name:
Address:
City:
State:
Zip Code:
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Phone Number:
e-mail Address:

Fill out for Credit Card Payments Only or call 1-509-276-7675
Credit Card Number:
Expiration Date:
 Month: \ Year:
Signature on Card:
_________________________________________________
Please Sign After Printing Form
Qty
SKU #
Item Description
Price
Subtotal
 Wt.
$59.95
 4 lb.
$4.25
 4 oz.
$13.60
1 lb.
$3.50
4 oz.
$2.00
4 oz.
$21.95
1 lb. 8 oz.
$35.00
2 lb.
$18.95
1 lb.
WA state residents ONLY:
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Thank you for your order! We appreciate your business!