BUCKLE BOSS

®

ORDER FORM

Print this form; fill it out; mail it in

1-5 UNITS	$14.00 each + S.&.H of $3.25 per order. MA residents add 5% sales tax per order.
6-11 UNITS	$13.00 each + S.&.H of $5.25 per order. MA residents add 5% sales tax per order.
12-20 UNITS	$12.00 each + S.&.H of $6.95 per order MA residents add 5% sales tax per order.

Number of units __________ times cost per unit		__________
MA resident, add 5% sales tax		__________
S&H charge per order (not per unit)		__________
TOTAL		__________

Name:	__________________________________________________
Address:	__________________________________________________
City, State, Zip:	__________________________________________________
Phone:	__________________________________________________
Email:	__________________________________________________

Make check payable to: GBY, Inc. Mail order and check to: GBY, Inc. Box 386 Lincoln, MA 01773 Sorry ... unable to accept phone or credit card orders at this time. Please direct all inquires to   PowersBuckleme@aol.com   or 781-259-9677