fax.gif (568 bytes)
Fax Order Form
708 563-0313
Item # Style Color Description Quantity Price
           
           
           
           
           
           
           
           
Subtotal:
Illinois residents add sales tax:
Shipping and Handling:
TOTAL: 		 
 
$15.00
 

 

 

 

 

 

 

 

 

First Name: ______________  Last Name:_______________________   
       
Address:__________________________   City:__________________

State:________________  Zip: ___________
                          
            
Day Phone:(____)__________     Night Phone:(____)__________     

         

    
Credit Card:    box.gif (94 bytes) Master Card     box.gif (94 bytes) Visa    Number: ______________
    
Exp:_______  Signature (required):___________________________
                           

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The Scottish Shop
Scottish Modern Enterprises  6115 S. Archer Road, Summit Illinois 60501
708 594-5773 FAX 708 563-0313