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

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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:______________________________________


Signiture:______________________________________

The Lake's End
9075 Boundaries Rd.
Thornport, Ohio 43076
Ph: 740-246-4843
Fax: 740-246-4850