Order Form for Paddles

Phone: (504) 277-6526  E-mail: rchapman@pirogue.com
FAX-ORDER FORM
PRINT form, then fax or mail your completed purchase order

Size Type Wood Price Amount Sub-Totals
4 Foot Canoe Cypress $40.00 ______ _____________
Ash $42.00 ______ _____________
Pirogue Cypress $40.00 ______ _____________
Ash $42.00 ______ _____________
5 Foot Canoe Cypress $42.00 ______ _____________
Ash $45.00 ______ _____________
Pirogue Cypress $42.00 ______ _____________
Ash $45.00 ______ _____________
Packing $5.00
Shipping _____________
TOTAL _____________

Ship To:
Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Adress: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State/Zip: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Phone: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Check Credit Card Number:______________________
Credit Card Name on Card:___________________________
Money Order Expiration Date:__________________________
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