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Shipping information (All US orders shipped by
UPS for $10 for 1-5 items and $20 for 7-12 items)
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| Ship to:____________________________________________________________________________________ |
| Address:___________________________________________________________________________________ |
| City/State:_______________________________________________________Zip:________________________ |
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Country:___________ Telephone:____________________________ Email Address: ________________________ |
| Billing information Check here if same as shipping address: |
| Name:_____________________________________________________________________________________ |
| Address:___________________________________________________________________________________ |
| City/State:_______________________________________________________Zip:________________________ |
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Country:___________ Telephone:____________________________ Email Address:________________________ |
| Method of Payment: ____Check or Money Order: Amount (US dollars): $__________ or _____Credit Card |
| Credit Card#:____________-____________-____________-____________ Expiration Date:_______/_________ |
| __________________________________________ ______________________________________________ |
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Cardholder's
Name (Please
print) Signature
(Required)
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| Order Total (including shipping as quoted above): $_______________________ |
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ITEM
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SIZE/COLOR
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PRICE
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QTY
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TOTAL
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The Ole Mill Country Store 126 North High Street
Mt. Orab, Ohio 45154 |
BY PHONE:
The Ole Mill Country Store (937) 444-3344 BY FAX: (937) 444-9274 |
Order by Phone or Fax
Simply print
out the blank form below,
then browse our products and use the blank form to fill in the items you would like to order. Then call or fax us! |