Leisure Time Product Worksheet
Our Addresses: Your Addresses:
Ground:
Ground: Residential O
Business O
Leisure Time
Name:____________________________
807 N. Mattis Ave.
Champaign, IL 61821
Address:_________________________
e-mail:
City:____________________________
info@leisure-time.com
State/ZIP:_________/_____________
Land Line:
e-mail:_________@________________
Fax Line: 1-217-352-4030
Phone:_(____)______-______________
======================================================= Method of payment: O Visa Card# ______-______-______-______ Select» O Mastercard One » O Discover Expiration Date: _________________ Method» O AMEX
O Debit Card
Signature (If mailing order):_____________________________________________
==================================================================
Order# Description Quantity Price Extension
Sub Total:
Illinois Residents add 7¾%:
Handling Charge: 3.99
Shipping: Actual UPS
TOTAL: ................................____________