Carter & Gruenewald Co. Inc

PO Box 40 Brooklyn, WI. 53521 Telephone Number 608.455.2411

ORDER FORM
Print this form and use it to place your order.

*Customer Information*	*Method of Payment*
Name:_______________________________	[ ] MASTER CARD [ ] VISA [ ] Case Credit
Address:_____________________________	[ ] DISCOVER CARD [ ]Check/Money Order
Address:_____________________________	Account Number Exp Date
City:________________________________	[ ][ ][ ][ ][ / ]
State:_______Zip Code:_________________	Signature_________________________________________
Country:_____________________________	E Mail Address____________________________________
Phone:_______________________________	Date Ordered:_________________________

	Item Total	___________________
$10 shipping in USA Offshore Actual Cost	Shipping Costs	___________________
5.5 % sales tax for Wisconsin Residents, 6.25 % sales tax for Illinois residents	Tax	___________________
Payment in US funds only	Total Cost	___________________

Call or Fax for INFORMATION on International Orders
Mail Completed Form with Credit Card Info, Check or Money Order TO:

Carter & Gruenewald Co. Inc.***P.O. Box 40 ***4414 Hwy 92***Brooklyn, WI 53521

Thank You For Your Business!!!!!!