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CHECK SIX ENTERPRISES
57588 SUNNYSLOPE * YUCCA VALLEY, CA 92284

PHONE: (760) 365-2327
FAX: (314) 454-1733
EMAIL: RUSS@CHECK6ENT.COM

Order Form

Print this form and mail with check or money order to Check Six Enterprises.
You may send credit card orders as well, 24 hours a day, 7 days a week.

ORDERED BY: SHIP TO:
(if different from Ordered by)

Name:

Address:

City, State, Zip:

Country:

Phone:

E-Mail Address:

Item Qty Description Size Color Design Price Total

1

2

3

4

5

Comments/Instructions:

Subtotal:

Sales Tax: delivery in
CA add 7.25%, MO add 6.85%

UPS Shipping and Handling*

TOTAL:

I would like to pay by:

Visa

MasterCard (circle one)

Account Number:

Expiration Date:

Check/money order enclosed in the amount of $ ____________

Signature: _____________

*UPS Shipping and Handling:

U.S. Orders totaling : $25 or less add $4.50, $26 - $50 add $6.50,
$51 - $100 add $8.00, $101 - $200 add $11.50, $201 - $400 add $15.00

No S/H charge for Note Cards or Lithograph

	ORDERED BY:	SHIP TO: (if different from Ordered by)
Name:
Address:
City, State, Zip:
Country:
Phone:
E-Mail Address:

Item	Qty	Description	Size	Color	Design	Price	Total
1
2
3
4
5
Comments/Instructions: