ORDER FORM

D BAR X LIGHTING
HORNS~A~PLENTY ANTLER ART

TO ORDER PRINT THIS PAGE AND FAX (TOLL FREE) TO 877-414-5109 OR CALL US AT 1-800-467-6599.

Name: __________________________________________________________________

Billing/Mailing Address: ___________________________________________________

City, State, Zip: ___________________________________________________________

Main Phone No(s): ________________________________________________________

Shipping Name: __________________________________________________________

Shipping Address: ________________________________________________________

City, State, Zip: ___________________________________________________________

Shipping Phone No(s): _____________________________________________________

Model No(s): ___________________________________________________  Quantity: _________  Price: ________  Pack/Ship: _______

Custom Options: _______________________________________________

Model No(s): ___________________________________________________  Quantity: _________  Price: ________  Pack/Ship: _______

Custom Options: _______________________________________________

Model No(s): ___________________________________________________  Quantity: _________  Price: ________  Pack/Ship: _______

Custom Options: _______________________________________________

Deposit Total: __________________________________________________

 

Circle One:  Visa    Mastercard    American Express    Discover

Credit Card No: ________________________________________________

Exp. Date: _____________________________________________________

Security Code: _________________________________________________

Signature: _____________________________________________________

We will contact you when we receive your fax to confirm all the details and let you know the expected completion date.

Thank you for your order:)