Indiana Army Surplus Order Form
Today's Date:
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First Name
Last Name
Bill To Address
City
State
Zip
Ship To Address
City
State
Zip
Phone Number
(
)
-
Email
How did you hear about us?
Visa
Mastercard
Discover
/
/
/
Exp
/
Check*
Money Order
Please make checks payable to :
The Supply Depot
Qty
Code
Item Name / Description
Size
Price ea.
Subtotal
2
wdbdup1
Woodland Camo Pants(This is only an example, this line is ignored)
M
24.95
49.90
Sub-Total
Shipping & Handling
Tax 7% (IN Only)
Total
Order Total Price ($)
Shipping Charge
.
0.01 - 25.00
$9.95
25.01 - 60.00
$11.95
60.01 - 125.00
$13.95
125.01 - 200.00
$17.95
200.00 and over
$21.95
Special Rates Apply for certain Items.
Check this box if you would like to receive information from time to time about our special offers or services.
* = Please note: Goods will ship only after checks clear.
Mail Order Form & Payment to:
Army Surplus, 3714 West 16th Street, Bedford, INDIANA, 47421