Fred's General Mercantile - Christmas Wreath Order Form

Wreath Order Form

24" Wreath - Quantity Price $39.00 Delivered Wreaths being shipped west of the Mississippi, Please add $2.00 each for additional shipping charge. Sorry, no deliveries to Alaska and Hawaii. No wreaths shipped after December 18, 2007.
Billing Information:	As appears on Credit Card!	Shipping Information:
Name:		Name:
Billing Address:		Ship to Address:
City:		City:
State:		State:
Zip:		Zip:
		Delivery Date
Additional Billing Info		Additional Shipping Info
Card: Yes No Please put on card:

Card Type:
Card #:
Security Code
Expiration Date:
E-Mail Address:

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