David Frizzell Merchandise

Merchandise Order Form

Please print this order form from your browser, fill it out completely and mail with payment. Please make sure all entries are legible and correct.

Date _________________________________

Name ______________________________________________________________

Address ____________________________________________________________

City ____________________________________ State ____________ ZIP Code _________

Telephone: (_______)___________________

FAX: (______)________________________ E-Mail:_________________________________________

Enclosed: q Personal Check q Money Order q Cashier's Check

QTY	DESCRIPTION	PRICE EACH	AMOUNT







NOTE: All prices are in U.S. Dollars. * Domestic Priority Mail Shipping & Handling: $4.60 International Global Priority Mail Shipping & Handling: Canada & Mexico - $9.00 All other countries - $11.00 * Domestic USPS Media Mail: $2.13 Make payable and mail to: Lakota, Inc. 1300 Division #301 • Nashville, TN 37203		Sub Total	$
		* US Priority Mail Shipping & Handling	$
		** International Shipping & Handling	$
		***** Domestic USPS Media Mail**	$
		TOTAL	$