Mail or Fax this Order Form to:

The Back Pack
PO Box 125
Ernul, NC 28527       252 244-0728 (phone/fax)
______________________________________________________________________________

Name ___________________________________________________ Date ______________2016

Address ________________________________________________Phone __________________

City __________________________________________________ State________ Zip _________

Qty

Item #

Title/Description

Price Each

Total

         
         
         
         
         
         
         
         
         

 
Credit Card Information    

 Number____________________________

 Expires_________ 

 Signature___________________________
 
 
Please circle one:

       Discover                 Master Card            Visa

Office use:

 Shipping Date _____BO shipping date________

 App # ________Check #________B #_______


Shipping & Handling Charges:

    15% of Sub-total
    $5.00 Minimum



 NOTE:
 Due to increases in shipping costs, this charge   
 may be adjusted based on our actual shipping 
 cost including packaging/handling at time of 
 purchase. Please include you phone number 
 on  this form in case we need to contact you   
 regarding your shipping charge.



 We ship by USPS or UPS


Sub-total _____________

S&H  _____________

Sub-total _____________

NC Res. - 6.75 % Sales tax 

____________

Total  _____________
.

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