Annie Z. Roach
1076 Mt. Gilead Church Rd.
Pittsboro, NC 27312
Phone/FAX 919-542-4649
azroach@mindspring.com
You May Phone/FAX/ email or snail mail your order!
DATE: _______________________
Shipping Information:
Name ____________________________________ Phone: _________________
Address __________________________________________________________
City/State/Zip _____________________________________________________
email: _________________________________ FAX
______________________
Payment Options: Check/Money
Order: Make payable to Annie
Roach
OR
VISA/MC _______________________________________ Expires: ___________
ITEM
QUANTITY UNIT
PRICE
TOTAL
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PRODUCT TOTAL: __________________________
Shipping:
US Postal Service: add $4.00
US Priority Mail: add $6.50 (1-3 day delivery)
For 6 or more items: add $8.00 (will ship priority mail)
Shipping & Handling:
_________________
Note: Please understand that shipping
charges reflect the cost of packaging
ORDER
TOTAL
_____________________ materials,
labor,
and gasoline. Thank you.