Order Form

If you wish to place an order, please fill out the necessary information below and phone, mail,
or e-mail 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)

__________

 $379.00

 

$ _______

 

 

 

 

 

 

Copperhead

(One-Man)

__________

  $399.00

 

$ _______ 

 

 

 

 

 

 

Cottonmouth

(Two-Man)

__________

 $434.00

 

$ _______ 

 

 

 

 

 

 

Mudbug

(Flatback)

__________

  $585.00

 

$ _______ 

 

 

 

 

 

 

King

(Guide)

__________

   $530.00

 

$ _______ 

           

 

 

 

Add Rigid Vinyl Rails for $60.00

 

$ _______ 

           

 

 

 

Spudholes: 1@$35.00/2 for $70.00

 

$ _______

 

 

 

Sub-Total

 

$ _______

 

 

 

  Packing

 

$      35.00

 

 

 

 Call for Shipping Costs per unit

 

$ _______

           

 

 

 

 TOTAL COST

 

$ _______

           

 

    (Billing Address)

Name________________________________

Address ______________________________  

City______________________ State _____   Zip _______

Phone______________________________            

E-mail: ______________________________________

___ Check    ___ Money Order     ___ VISA    ___ Master Card

Credit Card Number_______________________________________

Exp
Date _____________________ CID_________

 

Name on Card  __________________________________________

 

 (Ship To)
 

 Name_____________________________________

 

Address ___________________________________

       

City____________________ State ____ Zip _____ 

 



         Phone_________________________         

        
E-mail: _________________________

 

Form: 090414

     

Ron Chapman-Shipwright, Inc.

324 E. Solidelle St.

Chalmette, LA   70043

www.Pirogue.com                             Phone: (504) 277-6526             Email: Steve@pirogue.com