Order Form
If you wish to place an order, please fill out the necessary information below and phone, mail, or email your order. \
You
can pay by check, postal money order, or credit card. Allow two weeks for delivery.
| ITEM | DESCRIPTION | QUANTITY | UNIT PRICE | TOTAL PRICE |
| Canebrake | (One-Man) | __________ | $325.00 | __________ |
| Copperhead | (One-Man) | __________ | $345.00 | __________ |
| Cottonmouth | (Two-Man) | __________ | $399.00 | __________ |
| Mudbug | (Flatback) | __________ | $475.00 | __________ |
| King | (Guide) | __________ | $475.00 | __________ |
| Sub-Total | $ _______ | |||
| Packing | $ 35 . 00 | |||
| Call for Shipping Costs per unit | $ _______ | |||
| TOTAL COST | $ _______ |
|
(The
shipping price is for delivery to a Business Address or pick-up at terminal) (Invoice) (Ship To) Name________________________________ Name_____________________________________ Address
______________________________ Address___________________________________ City______________________
State _____ City________________________ State ___ Zip ____________ Zip
______________ Phone______________________________ email: ______________________________________ ___Check ___Money Order ____ VISA ___ American Express ___Master Card Credit Card
Number________________________________________ Exp Date _________________ Name on Card
__________________________________________________
|
Ron Chapman-Shipwright, Inc
www.Pirogue.com Ph: (504) 277-6526