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 Order Form

Products Catalog - Order Form Page: 1

Use this form to place your order. Just print out, fill in all the necessary information and then send to the
address below with your check or money order made payable to C. J. Tustison Assoc.

Customer Information

Name________________________________	Telephone(daytime)__(______)________________
Mailing Address________________________	Telephone(evening)__(______)________________
City/State/Zip__________________________	Email____________________________________

Order Information

Item #	Qty	Item Description (incl Size/Color)	Price	Total Price
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________
__________	_______	______________________________________	__________	__________

	Merchandise Total	_____________________________
	Wisconsin residents pay 5.5% sales tax
	Delivery Charge (see chart below)*	_____________________________
		=========================
	TOTAL	_____________________________

* Shipping rates are for United States delivery only.

Please make checks or money order payable to:	Delivery Charges: For orders totalling:
C. J Tustison Associates	up to $9.99 = $4.45
P.O. Box 426	$10.00 to $49.99 = $8.15
Lone Rock, WI 53556	$50.00 to $99.99 = $12.20
	$100.00 to $199.99 = $24.50
Phone: (608) 583-2056 (Monday-Friday, 9 am to 4:30 pm)	$200.00 + Please call or email for Shipping & Handling