Amethyst Shipping

Order form

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Please fill out, print, and mail this form to:

Amethyst Products

194 N. Greenville Rd.,

Stanton, MI 48888

Name
Address
Phone
Shipping address if different from above
Item Number/ Qty/Price ea/total price
Item Total
Shipping/Handling (see chart)
Total Amount Enclosed
Check
Money Order
Cashiers Check
Credit Card
Charge this to my:
Card Number
Card Expiration Date
Enter E-mail Address

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