| I have read and agree to the terms as stated. |
Sub Total
__________ |
| _________________________________
_____________ |
Shipping & Handling ___$5.00___ |
| Customer Signature
Date |
WY Res. add 6% Tax __________ |
| Check: Make Payable to BigHorn Design |
Total Due
__________ |
|
|
| Visa MC Disc (circle
one)#____________________________ |
Exp:________________________ |
| Resale License Number
(Dealers)______________________________________________________ |