| Order Form |
Print this page from your computer and mail or FAX it to:
The Hermit's Grove |
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Your Name: ______________________________________________________________________________________________ Street Address/P.O. Box: ___________________________________________________________________________________ City: ______________________________________________________________________State: _________ Zip: ___________ Phone number if we must reach you: _________________________________________________________________________ Method of payment: ____ Check or U.S. Money Order ____ MasterCard ____ Visa Card Number: ______________________________________________________________ Expiration Date: _______________ Name as it appears on card: _________________________________________________________________________________ Signature as it appears on card: _____________________________________________________________________________ Zip code of billing address: _________________________________________________________________________________ |
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| Quantity | Description | Unit Price | Total Price |
| Total | |||
| Shipping | |||
| Discount | |||
| Sales Tax (WA only add 9.0%) |
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| ORDER TOTAL | |||