Mail or Fax this Order Form to:

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


Name __________________________________________ Date ____________2007

Address _______________________________________ Phone ________________

City ______________________________________ State _______ Zip ___________

Qty

Publisher

Title/Description

Price Each

Total

         
         
         
         
         
         
         

 
Credit Card Information    

 Number____________________________________

 Expires_________ Signature_____________________
  Please circle one:

       Discover                 Master Card            Visa


Sub-total _______________

S&H  _______________

Sub-total _______________

NC Res. - 6.5 % Sales tax_________

Total  _______________
.


Office use:

 Shipping Date _________BO shipping date_________

 App # _____________Check #________B #_______

(revised July 2007)


Shipping & Handling Charges:
    10% of Sub-total
   $4.00 Minimum
 
We ship by US Postal Service or UPS

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