Duck In Cigar Outlet Order Form, Selbyville, Delaware

Questions and Orders:
1. Print out form below and mail with order and payment.
2. Fax in your order 24 hrs. a day, toll free: (888) 395-7439
3. Use our Secure E-Mailable Order Form

Duck In Cigar Oulet
Route 4; Box 155
Selbyville, Delaware 19975
(302) 436-9924 or (888) 463-1516

PLEASE NOTE: OVERSEAS ORDERS MAY NOT BE CALLED IN. THEY WILL ONLY BE ACCEPTED VIA EMAILABLE FORM, FAX OR MAIL. PLEASE MAKE SURE ALL INFORMATION IS COMPLETE TO ASSURE PROMPT SHIPMENT.

Bill To:
Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Provence_______________________________________ Country ____________________

Phone Number ______ - ____________________

Ship To (if different than Bill To):
Name______________________________________________________________________

Address____________________________________________________________________

City____________________________________________ State_____ Zip ______________

Provence_______________________________________ Country ____________________

Phone Number ______ - ____________________

Brand Description Qty. Price Ea. Total

________ ________________________________________ ______ ________ ________

________ ________________________________________ ______ ________ ________

________ ________________________________________ ______ ________ ________

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________ ________________________________________ ______ ________ ________

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________ ________________________________________ ______ ________ ________

Subtot. $_______ $_______

Ship. $_______ $_______

TOTAL $_______ $_______

METHOD OF PAYMENT: (circle one) VISA MC DISCOVER

Credit Card No._________________________________________ Exp. Date _______________

Signature (as appears on card) ____________________________________________________

______ Check (Please allow 2 weeks for check to clear) ______ Money Order

PLUS COST OF SHIPPING.

DUCK IN HOME PAGE | CATALOG INDEX | E-MAIL US

Brand	Description	Qty.	Price Ea.	Total
________	________________________________________	______	________	________
________	________________________________________	______	________	________
________	________________________________________	______	________	________
________	________________________________________	______	________	________
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________	________________________________________	______	________	________
________	________________________________________	______	________	________
________	________________________________________	______	________	________
________	________________________________________	______	________	________
		Subtot.	$_______	$_______
		Ship.	$_______	$_______
		TOTAL	$_______	$_______