French Version -- Diaper Diary Order Form
Send your order and make payment to:
We accept:
B. Wilson-Clay/Kay Hoover Joint Venture Credit Cards (Visa/MC)
12710 Burson
Personal Checks
Manchaca, TX 78652
Purchase Orders
512-292-7227 Fax 512-292-7228
EIN# 74-2923741
E-mail to: bwc@lactnews.com
Name:_____________________________________________________________
Address:___________________________________________________________
Dept. (Room #):_____________________________________________________
City: _______________________________________State: ____Zip:__________
E-Mail:_____________________________________ Phone:_________________
Credit Card or Purchase Order Number:_________________________________
Credit Card Type (Visa/MC only ):__________________Exp. Date:___________
Signature:_________________________________________________________
Number of single pads: _____ at US $15.00 each
$_________
In quantities of 20 Pads: _____ at US $13.00 each
$_________
Sales Tax: TX or PA residents only.
Texas (8.25%) or Pennsylvania (7%)
$_________
U.S.
Shipping and Handling: $6.00 for 1 to 3
$9.00 for 4 to 10
$12.00 for 11 to 20
$_________
Total
$_________