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:
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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:
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Signature on Card:
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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.
$19.95
1 lb.
$18.95
1 lb.
WA state residents ONLY:
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Thank you for your order! We appreciate your business!