This Domestic Order Form Can Be Faxed or Mailed to:Silvermane, 149 Washington St, Haverhill, MA 01832 Billing Address: Name:___________________________________________________________________________ Address:________________________________________________________________________ City/State/Zip:_________________________________________________________________ Phone:__________________________________ E-Mail: ______________________________ Shipping Address: Name:___________________________________________________________________________ Address:________________________________________________________________________ City/State/Zip:_________________________________________________________________ Model Number Description Qty Price Total _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Subtotal: __________________ __________________ Shipping & Handling: __________________ Total: __________________ --------------------------------------------------------------------------------- Charge to my ___ Visa _____ Mastercard _____ Discover _____ AmEx Card No.: _______________________________ CVV2 No.: _____ Expiry Date: ____/____ Name on the card: _______________________________________________________________ Signature: ______________________________________ --------------------------------------------------------------------------------- Sign below if ordering any type of weapon: I certify that I am at least 18 years of age and that possession of the item(s) I am ordering does not violate any of my state or local laws. Signature: _________________________________________________ --------------------------------------------------------------------------------- Make checks or money orders payable to: Silvermane There is a $25 fee on all returned checks. Orders paid by personal check will not be shipped until the check clears our bank. See Ordering Information for shipping charges.
24-Hour Fax: (978) 374-7635
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Phone: 978-521-8074 Fax: 978-374-7635 E-mail:
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