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Robert Rosand's Order Form

Date:____________
Name: ___________________________________
 
Address: _________________________________
 
City: ____________________________________
 
State & Postal Code: _______________________
 
Phone Number: (______)________-___________
 
e-mail: __________________________________

Please copy and mail or fax to:
Robert Rosand
198 Dug Road
Bloomsburg, PA 17815
or
Phone: (570) 784-6158

Quantity

Item Description

Price

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$____________

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Total Of All Merchandise:

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Shipping Charges ($4.60 for most orders)
       Most orders will be sent USPS Priority Mail.

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Pennsylvania residents add 6% sales tax

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Total Amount Due:

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At present we are not accepting credit cards. Please feel free to call about your order or any special orders