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Please print a copy of order form then click back button to return to Order Web Page

____________________________________________________________

 

Strum-Tar Order Form

Mail To:    Strum-Tar Instruments Inc.         

                  4513 Brinker Driver

                  Virginia Beach, Virginia 23462

 

Make checks or money order  payable to:  C. T. Doddy.  

 

Date:_______________

 

First Name:______________ Last Name:__________________

Address:___________________________________

City:________________State:______________

Zip:_______________________

Phone: (             )______-____________

E-mail Address:____________________@_________________________

 

Ordered Items

 

1.      Model Number:__________ Unit Price:________ Qty:_____ Total Price:_________

2.      Model Number:__________ Unit Price:________ Qty:_____ Total Price:_________

3.      Model Number:__________ Unit Price:________ Qty:_____ Total Price:_________

4.      Model Number:__________ Unit Price:________ Qty:_____ Total Price:_________

5.      Model Number:__________ Unit Price:________ Qty:_____ Total Price:_________

                                                                       Virginia Resident add 4.5% Tax_______

                                                                                   Shipping and Handling:  $12.00

                                                                                                        

                                                                              Total Amount:_________

 

Reference Order Number:___________(Use yymmdd birthday as Order Number: Example 111850)

 

Cut Here and Save as Order Record

 

Strum-Tar Instrument Inc.   Phone 757-474-1630

Date:______________

 

Reference Order Number:_________(Use Order Number listed above)