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PLEASE PRINT THIS MAIL ORDER FORM--WHEN FINISHED HIT YOUR BACK BUTTON

PLEASE INCLUDE ITEM NAMES AND QUANITITIES FOR WHAT YOU ARE BUYING.WE ACCECPT PERSONAL CHECKS OR MONEY ORDERS
INCLUDE THE SHIPPING COST WITH EACH ITEM.MN RESIDENTS MUST PAY 6.5 SALES TAX

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PLEASE SEND CHECK OR MONEY ORDER PAYABLE TO
BRUCE HIGLEY
911 22ND AVE SOUTH
SUITE 148
MINNEAPOLIS,MN 55404 Phone 763-438-0356

Qty________________________________________________________________________________________________________________

Sub Total___________________________________________________________________________________________________________________

Total Shipping_______________________________________________________________________________________________________________

Mn
Sales Tax(mn residents only)_________________________________________________________________________________________________

Grand Total_________________________________________________________________________________________________________________
Ship To:

Your Name________________________________________________________________________________________________________________

STREET Address____________________________________________________________________________________________________________

CITY___________________________________________________________________________________________________________________
STATE

ZIP CODE_________________________________________________________________________________________________________________

DAY PHONE_________________________________________________NIGHT PHONE__________________________________________
EMAIL

ADDRESS__________________________________________________________________________________________________________

SPECIAL INSTRUCTIONS___________________________________________________________________________________________________

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