Nikki’s
Pony Express
Mail
In Layaway Order Form
13 Rose Court
Middlebury, Ct. 06762
203-758-2354
DATE:
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Bill To: |
Ship To: |
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Name |
Name |
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Company |
Company |
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Address |
Address |
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City, |
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Phone |
Phone |
Comments or Special Instructions: If
there are any special instructions please include them in the comment box.
Method of Payment: Personal Checks, Money Order or Credit Card VISA______, Master Card______,
American Express______ or Discover______
Card Number ____________________________ Exp. Date ____________ (Month/Year)
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QUANTITY |
DESCRIPTION |
UNIT PRICE |
AMOUNT |
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SUBTOTAL |
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Ct. SALES TAX |
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SHIPPING & HANDLING |
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TOTAL DUE |
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Make all money orders/Checks payable to: Nikki’s Pony Express
If you have any questions, contact Gretchen at (203)
758-2354 or email us at kml@nikkisponyexpress.net
THANK YOU FOR YOUR
BUSINESS!
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