| Name: | ________________________ | Phone: | ________________________ |
| Address: | ___________________________________________________ | ||
| City: | ________________________ | State/Province: | ________________________ |
| Zip Code: | ________________________ | Country: | ________________________ |
| Email: | ___________________________________________________ | ||
| PRODUCT NUMBER | QTY | DESCRIPTION | SIZE | PRICE PER UNIT |
SHIPPING | TOTAL $ |
| MENS-002 | 2 | EXAMPLE: Lucky Mule Pinup Girl | M | $ 15.00 | $ 5.50 | $ 35.50 |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| PLEASE LIST YOUR ALTERNATE CHOICES BELOW | ||||||
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
| __________ | ___ | __________________________ | ___ | $______ | $______ | $______ |
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Send this completed form along with your check or money order to:
Make checks and money orders payable to "Lucky Mule" The Lucky Mule / POBOX 23821 / Oakland, Ca / 94623 / USA |
TOTAL ORDER | |||||
| $ | ||||||
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