Mail/Fax Order Form:
Please return completed order forms and payment to:
Mailing Address:
Lava Creek Trading Company
369-B Third St. PMB #311
San Rafael, CA. 94901
FAX: (415) 459 - 0814
or contact us at:
PHONE: (415) 459 - 8848
All orders must have completed this information
Quantity ____________
Price ____________
Total ____________
Plus Shipping_____________
TOTAL AMOUNT _______________
Name ____________________________________
Mailing Address ________________________________________
City __________________________ State________________ Zip Code____________
Telephone_____________________________
E-MAIL_______________________________
Type of Payment (US Dollars only):
______ Check (enclosed) ______ Money Order (enclosed) ______ Visa ______ MasterCard
Credit Card Number ________________________ Expiration Date _________
Signature _______________________ Date _____________
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