Merchandise Order Form

Please print this order form from your browser, fill it out completely and mail with payment. Please make sure all entries are legible and correct.

Date _________________________________

Name ______________________________________________________________

Address ____________________________________________________________

City ____________________________________  State ____________  ZIP Code _________

Telephone: (_______)___________________

FAX: (______)________________________   E-Mail:_________________________________________

Enclosed:   Personal Check     Money Order   Cashier's Check

QTY

DESCRIPTION

PRICE EACH

AMOUNT

       
       
       
       
       
       
       

NOTE: All prices are in U.S. Dollars.

* US Priority Mail Shipping & Handling: $6.00
NOTE: Joining Fan Club requires no shipping or tax be added. 

** International
Global Priority Mail Shipping & Handling:
All countries - $15.00

Make payable and mail to:
Lakota, Inc.
1300 Division #301 • Nashville, TN 37203

 

Sub Total

$

* US Priority Mail Shipping & Handling 

$

** International Global Priority Shipping & Handling

$

TOTAL

$

Copyright © 2010 Jo Frizzell