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Name _______________________________________________________ Address _____________________________________________________ City ______________________________ State ______ Zip ___________ Telephone ___________________________________________________ E-Mail ______________________________________________________ Credit Card Type ________ Credit Card Expiration __________________ Credit Card Number ___________________________________________ |
Item# Description Quantity Price Total ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ |
Subtotal _________ Sales Tax ___________ Shipping ___________ Grand Total _________ |
Sales Tax: CT Residents add 6% |
Adirondax LLC P.O. Box 538 East Granby, CT 06026 860-844-0101 |
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Send Credit Card info., Postal Money order or Bank Check made payable to Adirondax LLC. |