RHODESIAN RIDGEBACK PERSONAL CHECK ORDER FORM

Please supply a street address. For security reasons,
orders can not be shipped to a P.O. Box.

Print & Mail with the above items to the address below

Name:
Street:
City: State Zip
Email:
Daytime Ph:
Evening Ph:
Fax No:

Check Enclosed   Visa  MC  Discover  AmExpress

Credit Card Information

Name: (exactly as it appears on card) 
Billing address - only if different from shipping address above
Street:
City: State: Zip:
Card #: Exp. Date:

CLIPART :
       $1 Per Box

ONE-PART CHECKS:
150 (1 box)     $13.95
300 (2 boxes) $27.90
450 (3 boxes) $41.85

TWO-PART CHECKS:
125 (1 box)     $13.95
250 (2 boxes) $27.90
375 (3 boxes) $41.85

SPECIAL LETTERING - $2.00 per order

LEATHER CHECKBOOK
COVER: - $10.95 each
Black     Burgundy

  START MY CHECKS WITH #:

SHIPPING
$1.50 1-2 Boxes of checks
$3.00 3-4 Boxes of checks

Check Price.....$
Special Lettering - $2.00.....$
Clipart: $1.00 per box.....$
Leather Checkbook Cover: $10.95.....$
Shipping & Handling - (see above).....$
Priority Mail - $4.60.....$
Subtotal.....$
Sales Tax:  (7.05%) KS only.....$
Total Price.....$

PRINT AND FAX OR MAIL TO:
PARAGON BUSINESS FORMS
2125 Crawford Place   ·  Salina, KS 67401
Voice: (800) 325-1994   ·  Fax: (888) 554-4116