Rustic Creations home

(Print out this form.) 


Name:_________________________________    Phone:____________________

Address:____________________________________________________________

City:____________________ State/Province:____  Postal Code__________

Country:_________________	E-mail: ____________________________
                                       (For Order confirmation, and communications only.)
Ship to address (if different than purchaser):
Name:_________________________________    Phone:____________________

Address:____________________________________________________________

City:____________________ State/Province:____  Postal Code__________
Item # Item Description Qty   Price   Extended
__________ _______________________________________ ___ $ _______ $ ________
__________ _______________________________________ ___ $ _______ $ ________
__________ _______________________________________ ___ $ _______ $ ________
__________ _______________________________________ ___ $ _______ $ ________
__________ _______________________________________ ___ $ _______ $ ________
 
  Additional shipping (if required).       $ ________
  MI residents add 6% sales tax.       $ ________
--------------------------------------------------------------------------------------------
        Total $ ________

OR include check or money order (payable to K-S Marketing)

Then mail to:
  Rustic Creations  
  732 N. 6th Ave.  
   Iron River, MI 49935  
   USA

Phone: 888-5-RUSTIC (toll free)
Fax: 866-731-0067 (toll free) 		  
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