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. This form contains the same information fields as secure order form

*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!!!!!!