The Lake's End / Special T's: Print Fax Form

THE LAKE'S END / SPECIAL-T'S FAX FORM Phone it in @ 740-246-4843... Fax it in to 740-246-4850... or Mail it in to:

The Lake's End / Special-T's
9075 Boundaries Rd.
Thornport, Ohio 43076

Print and save this order form and copy for easy ordering.
Company Name:_________________________________________________
Bill To:______________________________________________________
Address:______________________________________________________
City:_________________________________________________________
State:_________________________Zip Code_______________________
Phone #'s:____________________________________________________
Ship To (if different):_______________________________________

Item	Description	Color	Quantity	Unit Cost	Ext. Cost
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...				Sub Total	...
				Sales Tax	...
				TOTAL	...


Method of Payment:

Check_____________Cash______________Company Charge#______________


Bank Card Name:_______________________________________________


Bank Card #:__________________________________________________


Exp. Date:______________________________________


Security Code:__________________________________ (3-digit)


Signiture:______________________________________

The Lake's End / Special-T's
9075 Boundaries Rd.
Thornport, Ohio 43076
Ph: 740-246-4843
Fax: 740-246-4850