MasterCard Accepted

Mail In Order Form
 VISA Accepted

To print this form: Please select "file" and then "Print"

Mail To:
Hothem House
P.O. Box 458
Lancaster, OH 43130

* FIRST NAME
E-Mail Address
* LAST NAME
PHONE
* ADDRESS
UNIT
* CITY
  
* STATE
   PLEASE TYPE YOUR INFORMATION BEFORE PRINTING
* ZIP
   INSTEAD OF WRITING IN AFTER PRINTING.
  * = indicates required field
THIS HELPS US COMPLETE YOUR ORDER FASTER
       
  Line Item Name / Title Price
  1
  2
  3
  4
  5
  6
  7
  8
  9
  1-
       

 

Credit card#________________________________________________________ Expiration_______________
Shipping Charges
Purchase
Total
  
Postage
Rate
$0.01 –$50.00
  
$4.00
$50.01 –$100.00
  
$7.00
$100.01 –$150.00
  
$9.00
$150.01 –$300.00
  
$12.00
$300.01 and up
  
$18.00

 

 

Questions? phone: 740-653-9030
fax: 740-653-2262 E-Mail US!
This is not a secure site for submitting credit card information by email

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