ORDER INFORMATION: CURRENT CUSTOMER     YES   NO

NAME:
ADDRESS:
CITY: STATE / PROVINCE:ZIP:
DAYTIME PH #: E-MAIL:

SHIPPING ADDRESS (IF DIFFERENT)

NAME:
ADDRESS:
CITY: STATE /PROVINCE:ZIP:

SPECIAL SHIPPING INSTRUCTIONS

METHOD OF PAYMENT
CREDIT CARD: VISA  MASTERCARD  DISCOVER

BILLING ADDRESS (If different than shipping or contact address) 
CITY: STATE: ZIP:

ACCOUNT #:
EXPIRATION DATE: 3 DIGIT SECURITY CODE-BACK OF CARD:
NAME ON CARD:         

 Thank you for your order-just click on the submit button for your order to be processed.
 Most orders processed in 24 hours or less.  
If you prefer to send your information by mail, fill out form, print and mail to address above. 
Thank You, Eidnes Furs, Inc.