
QWICKSILVER
ORDER FORM
Please send _____ Qwicksilver plates @ $32. ea. __________
Plus $2.00 Shipping & Handling __________
ACCESSORY ITEMS:
Jewelry cleaning plate @ $11.00 _________
Luster cloth @ $6.00 _________
Plus $1.00 per Acces. item ship/hand. _________
(no additional S/H if ordering large plate)
TOTAL $_______________
Name _________________________________________
Address _______________________________________
City ____________________ St
_______ Zip _________
Checks payable to: C & S Enterprises
1018 Antelope Tr.,
# ________________________________Exp._________
Card name: _____________________________________
Signature:
______________________________________
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