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 6.25% sales tax per order. 6-11 UNITS $13.00 each + S.&.H of $5.25 per order. MA residents add 6.25% sales tax per order. 12-20 UNITS $12.00 each + S.&.H of $6.95 per order MA residents add 6.25% sales tax per order.

Number of units ______ times cost per unit__________ = __________ MA resident, add 6.25% sales tax  __________ S&H charge per order (not per unit)  __________ US currency  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