Order Form

Name: ___________________________
Shipping Address:
Address: ___________________________
City, State, ZIP ___________________________
Phone Number: ___________________________
E-mail Address: ___________________________

Billing Address:  (If different from shipping address)
Name: ___________________________
Address: ___________________________
City, State, ZIP ___________________________

Stock Number Description Quantity Unit Price Total Price
         
         
         
         
         
         
         
         
         
Sub Total:  
Add $10.95 for Ground Shipping/Handling:  
 Retail Sales Tax:  
Total Price:  

Payment Information: 
___ Credit Card      ___ Personal Check      ___ Money Order

Credit Card Information: ___Visa   ___MC   ___AMEX   ___Discover 

Credit Card Number:______________________________________________ Exp. Date: _______

Check here if you would like to become a preferred customer  __________

Please mail this form to: 
Cheri McCain, Neways Distributor
905 1/2 Fourth Street, La Grande, OR 97850

Please make any checks payable to Cheri McCain, Neways Distributor
If you have questions, call us at 541-663-8680