Retail Order Form

Please enter information for order below and we will contact you to confirm your order.

Customers First Name

Customers Last Name

Address 1

Address 2

City

State

Zip Code

Ship To Address Yes No

(If No enter ship to address in field to right)

Phone Number (Required)

Best Time to Call

Cell Number

Best Time to Call

E-Mail Address

Enter information accurately

DO NOT STORE CREDIT CARD INFO ON THIS FORM

Enter Number of Each Unit Ordered Below the Mailbox Style
Mailbox II Price $249.95 + Shipping # of Style II	Mailbox IV Price $249.95 + Shipping # of Style IV	MailboxV Price $249.95 + Shipping # of Style V
Enter Salesmans Name Below If Known Leave Blank if Unknown Enter Special Instructions Here:

All personal information is to be kept secure and only be used as transactions may require.