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DUCKSCRUBS.com |
Print this form out.
Mail or Fax this ORDER FORM
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Uniform Express
144 Whetstone Drive
Mocksville, NC 27028
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Telephone 336-284-6377 |
| Fax 336-284-2399 |
| Email info@duckscrubs.com |
We accept Visa
and Master Card, Money Orders, Bank Checks Only. No personal checks
accepted.
Customer
Billing Information
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Name:
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| Street
Address: |
| City |
State: |
Zip: |
| Daytime
Phone: |
Evening
Phone: |
| Credit
Card Number (Master
Card or Visa Only) |
| Name
on the Card |
| Expiration
Date |
| Last
3 digits on back of card |
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*
If
this order needs to be shipped to another
address, please print below:
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| Ship
to this address: |
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Name:
|
| Street
Address: |
| City |
State: |
Zip: |
| Daytime
Phone: |
Evening
Phone: |
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Please fill out form below to order uniforms.
ORDER FORM
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Item
#
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Description
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Color
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Size
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Qty.
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Price Each
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Total
Price
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Total Merchandise
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Shipping
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$5.00
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Total
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Please
send this order along with credit card payment , cashier’s check or
money order to:
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Uniform Express |
144
Whetstone Drive
Mocksville,
NC 27028
Phone Number
- 336-284-6377
FAX
Number -
336-284-2399
info@duckscrubs.com |
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