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Brandon Bait and Tackle Accept Visa, MC and Discover

Phone 405 359-3886 Checks & Money Orders Date:________________

Fax 405 605-2697

Name_______________________________________

Street Address_______________________________

City, ST, Zip__________________________________

Phone______________________________________

Qty Item# Description Unit Price Total

_____ _______ _________________ _______ ________

Shipping Standard Delivery Discount _________

Merchandise Total Price Sub Total _________

$0.01- $15.00 $4.00 Sales Tax (OK) _________

$15.01-$40.00 $5.50 Shipping _________

$40.01-$75.00 $7.50 Total _________

$75.01-$100.00 $9.50

$100.01-up $12.50

Please Check Type of Payment _____Personal Check or Money Order Payable To Brandon’s Bait & Tackle

___________Visa_______________Master Card____________Discover
Name_____________________________Card Number_____________________

Expiration Date______________3# code on back of card___________

Signature__________________________________________

Thank you for your Business!

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