Eileen Melton
Phone: (573) 996-7390

Order Form

Name: Please send me the following:

Address:		 QTY

Title

 Amount

City:		      

State:		      

ZIP Code:		      

Phone:		      
Enclosed is my check for: $________

Sub total:

  
(Make checks payable to: Eileen Melton)

Insurance (optional):

$3.00

Shipping and handling:

$7.95

Total:

  

Mail Order to the following address:
Eileen Melton
Rt. 2, Box 6585
Doniphan, MO. 63935

Dealer Inquires Welcome!