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 |
|
|
|
|
|
|
|
(One-Man) |
__________ |
$379.00 |
__________ |
|
|
|
|
|
|
|
|
(One-Man) |
__________ |
$399.00 |
__________ |
|
|
|
|
|
|
|
|
(Two-Man) |
__________ |
$434.00 |
__________ |
|
|
|
|
|
|
|
|
(Flatback) |
__________ |
$585.00 |
__________ |
|
|
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|
|
|
(Guide) |
__________ |
$530.00 |
__________ |
|
|
|
|
|
Spudholes: 1 @ $35.00/2 for $70.00 |
$ _______ |
|
|
|
|
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______________________________ E-mail:
______________________________________ ___Check
___Money Order ____
VISA ___Master Card Credit Card
Number________________________________________ Exp Date
_________________ Name on Card
__________________________________________________ Form: 121311 |
Ron Chapman-Shipwright,
Inc.
324 E. Solidelle
St.
Chalmette, LA 70043
www.Pirogue.com Phone: (504) 277-6526 Email: Steve@pirogue.com