Order Form
Address correspondence to:
To place orders by phone, please call 503‐502‐8351. Orders may be faxed to 503‐717‐1552.
FosterClub 753 First Avenue Seaside, OR 97138 Order Date:
BILL TO:
SHIP TO:
Name:
Name:
Address:
Address:
City, State, Zip:
City, State, Zip:
Phone:
Phone:
E‐mail
E‐mail
Item #
DescripQon
Size/Color/Special Info
3/2/10
Cost Per
[42]
QuanQty
Subtotal
SUBTOTAL
0.00
Payment InformaQon
SHIPPING
0.00
Payment Method:
OTHER
0.00
TOTAL
0.00
Visa
Credit Card #: ExpiraQon Date: Code: Name on card: Signature:
MasterCard
American Express
Check*
P.O*
Notes + special instrucQons