Print and complete this form, then fax or mail with payment to:

Malec's Enterprises. • 3870 Stirrup Drive. • Erie PA 16506

FAX: 814-864-9171

RETURNS MAY BE SUBJECT TO RESTOCKING FEE

ShipTo:

Name __________________________________

Address________________________________

City ___________________________________

State _______ Zip ______________

Phone _______________________

E-mail: _______________________

Shipping Charges:

Shipping
Over $500

... $10
... FREE

Payment Method:

[ x] Check [x ] Money Order [x ] PayPal [x ] Visa [x ] Mastercard [x ] American Express

Card # _______________________________________ Exp. Date: _______

Make check payable to: Malec Enterprises

Qty.

Description (MUST ALSO INCLUDE SIZE & COLOR)

Price Each

Sub Total





















Subtotal:



TOTAL:

$

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