HM Page Order Form

NAME: PHONE:
ADDRESS: EMAIL:
CITY: STATE: ZIP: DATE:
Note: Numbers in parenthesis refer to explanations. Click Here for Help.
No.	Item # (1)	Description (2)	Price (3)
1.	_{_______________}	___________________________________	___________
2.	______________	___________________________________	___________
3.	______________	__________________________________	___________
4.	______________	__________________________________	___________
5.	______________	__________________________________	___________
6.	______________	__________________________________	___________
7.	______________	__________________________________	___________
8.	______________	__________________________________	___________
		(4) ORDER SUB TOTAL	___________
		(5) less ALLOWANCES	___________
		(6) SUB TOTAL	___________
		(7) SHIPPING (CLICK HERE)	___________
		(8) NET ORDER VALUE	___________
		(9) less CREDITS/DISCOUNTS	___________
		(10) SUB TOTAL	___________
Your Ck/Mo # __________		(11) VIRGINIA RESIDENTS ONLY SALES TAX (4.5%)	___________
		(12) TOTAL AMOUNT DUE	___________