IHC-Squeaky Sam's Order Form

Please fill out the form below. We will fill your order as quickly as possible.
Thank you.

Use Tab Key To Move Between Fields



Last Name:   
First Name:  
Company:     
Address:     
City:        
State:       
ZipCode:     
Country:     
Telephone:   

Email:       


Gender:       Male
              Female

Computer system you are using: 




 Enter your order



     

          #
          ITEM NAME
          PRICE
          QTY
          TOTAL
     

     

          1
          
          
          
          
     

     

          2
          
          
          
          
     

     

          3
          
          
          
          
     

     

          4
          
          
          
          
     


     

          5
          
          
          
          
     

     

          SUBTOTAL
          
     

     

          MI RESIDENTS ADD APPROPRIATE SALES TAX
          
     

     

          TOTAL ORDER
          
     

     


Method of Payment:

 CHECK

 MONEY ORDER

 COD
(Sorry, we do not accept credit cards.)

Click on Submit or Reset, select "back" then select Return to Home
Comments or Questions:(1000 characters max):

Return to the Home Page