OFF THE WALL
MAIL IN ORDER FORM

Send Check or Money Order to:

OFF THE Wall
RR 1 Box 1017
Bridgton, ME 04009-9755

Queries may also be sent to: barefoot@offthewallemporium.com
or phone: 207-647-3734
     fax: 207-647-5801

Please print out this form and fill in the appropriate information: (Please Print or Type Information)

Your Name____________________________________________________________
Street Address_______________________________________________________
City___________________________________________________
State_______________________________________
Zip______________________________
Phone__________________________
E-Mail Address__________________________________________

Shipping Address if Different From Above:
Name__________________________________________________________________
Street Address________________________________________________________
City_____________________________________________________
State___________________________________________
Zip_______________________________


ORDER:

HUNTER'S HANDY HANDS:

Quantity_____________ at $10.95 each ________________________
       add $5.00 shipping each ________________________
   TOTAL COST__________________________

Allow 4 to 6 weeks for delivery upon receipt of payment.