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
1438 W. Willow St.
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: _________________________