Dobbins Products 208 Earl Drive Goldsboro, NC 27530 (919) 580-0621 |
Name _______________________________________________________________ Address ____________________________________________________________ City _______________________ State _______________ Zip Code ____________ Telephone ______________________ E-Mail ______________________________ Shipping Address (if different) ___________________________________________ ___________________________________________________________________ Payment Method _____Check _____Money Order _____Visa _____MasterCard Credit Card Number ________________________ Expiration Date ____________ Authorized Signature _________________________________________________ Item Number Quantity Description Price ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ ____________ _______ _______________________________ ________ Shipping Charges Total ________ Up to $49.99 - Add $9.00 $50.00 - $99.99 - Add $12.00 Shipping Charges ________ $100.00 - 200 - Add $15.00 Grand Total ________ Alaska & Canada pay exact shipping |
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