
QWICKSILVER ORDER FORM
Plus $3.00 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: ______________________________________
1-2010 update