Order Form
Please print out this order form and send to:
Jean S. Lyle • P.O. Box 289 • Quincy, Illinois 62306-0289
Fax to: (217) 222-6053

Name:________________________________________________________________________

Address:______________________________________________________________________

City:_____________________State:________________Zip:_____________________________

Daytime Phone: (_____)__________________________________________________________

Quantity	Description	Price	Shipping	Amount
Mail Order To: Jean S. Lyle P.O. Box 289 • Quincy, Illinois 62306-0289 or Fax to: (217) 222-6053 (217) 222-8910 • Email: jslyle@adams.net			Subtotal
			IL Residents Add 7% Tax
			TOTAL

Payment Method:
___Check or Money Order Enclosed
___Please Charge To My Credit Card	___	___

Credit Card Number:

Expiration Date:

X____________________________________
Signature Required for Credit Card Orders

 

Thank You For Your Order!!

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