FIRST NAME:
LAST NAME:
STREET:
CITY:
STATE:
ZIPCODE:
EMAIL:

ITEM#	QUANTITY	DESCRIPTION	PRICE EACH	TOTAL PRICE
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$

SUB TOTAL:	$
MINNESOTA RESIDENTS MUST ADD 6.5% SALES TAX:	$
SHIPPING & HANDLING:	$
TOTAL AMOUNT:	$
(if using layaway plan) 25% DOWN:	$