Please print this on your printer and mail to Stamp N Plus Scrap N at the address on upper left of form.

Stamp N Plus Scrap N
P.O. Box 47
Chippewa Falls, Wi.54729 
Phone: 715-271-1873 fax to 715-720-6176

Customer Order Form
SHIP TO:
NAME ________________________________
ADDRESS _____________________________
CITY,STATE,ZIP_________________________
______________________________________
YOUR EMAIL ADDRESS ____________________
TELEPHONE NUMBER _____________________ 		To receive a FREE GIFT with your order, fill in your local distributor's ID number here:

DIST ID#        ___________________

DIST NAME: ___________________

QUANTITY

 ITEM NUMBER

 PG.#

    DESCRIPTION

     EACH

 TOTAL
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
 

SUBTOTAL

    
 

SHIPPING  

  

%7 (minimum $3.85)
 

WISCONSIN RESIDENTS ADD

 5.5% Tax  
 

GRAND TOTAL

    
CREDIT CARD INFORMATION _VISA  _M/C  _DISCOVER  _
ACCT# ______________________________ EXP DATE _______________
NAME ON CARD _____________________ SIGNATURE: _________________________