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ALASKA DYEWORKS
322 OGDEN ST., P.O. BOX 697
VILLAGE OF OXFORD, NEBRASKA 68967-0697
PHONE/FAX (308) 824-3540 or ORDER 1-800-478-1755
e-mail:  Victoria Barnett, akdye@akdye.com

ORDERED BY:	SHIPPING ADDRESS:
NAME:

NAME:

ADDRESS:

ADDRESS:









E-MAIL:



PHONE:

PHONE



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[  ] UPS PRIORITY -- ESTIMATE 10%; MINIMUM $4.60		
A CREDIT WILL BE ISSUED ON OVER ESTIMATES PAID		SUB-TOTAL:		

HANDLING IS $1.00 PER BOX		HANDLING:	____$1.00____

VISA/MASTER CARD/DISCOVER NUMBER		ESTIMATED SHIPPING:	____$4.60____

		BALANCE DUE:		


EXPIRATION DATE:  		



SIGNATURE:  	
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