ORDER DATE: _______________

ALASKA DYEWORKS
322 Ogden St., Village of Oxford, Nebraska 68967-0697
PHONE/FAX (308) 824-3540
e-mail: Victoria Barnett, akdye@akdye.com

ORDERED BY: SHIPPING ADDRESS:
NAME: NAME:
ADDRESS: ADDRESS:
  
E-MAIL: 
PHONE: PHONE

EACH

COUNT

SIZE

COLOR/DESCRIPTION
TOTAL

COUNT
EACH PRICE
EXTENSION

PRICE
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

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

VISA/MASTER CARD/AMERICAN EXPRESS NUMBER

EXPIRATION DATE:  

SIGNATURE:  

 HANDLING SUBTOTAL:

ESTIMATED SHIPPING:

BALANCE DUE:

  

___$4.60___

 

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