NAME: _________________________________________________
ADDRESS________________________________________________
CITY: ___________________________________________________
STATE: ________________________ ZIP: ______________

EMAIL ADDRESS: _______________________________________
TELEPHONE: # ___ ___ ___/___ ___ ___/___ ___ ___ ___

.

VISA____ MASTERCARD____ AMERICAN EXPRESS____

CARD NUMBER: __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __

CARD EXPIRATION DATE: ____/____

SIGNATURE IS REQUIRED:

X _________________________________________________

CHECK____ MONEY ORDER____
PLEASE FILL IN NUMBER OF EACH ORDERED:
Wedding Items Sources Directory $10.00______
Gift Basket Merchandise Wholesale Sources Directory $20.00_____
Dollar Store Merchandise Wholesale Sources Directory $20.00____
Shipping charge is $3.00 per Directory
TOTAL PAYMENT ENCLOSED $___________

SHIP TO NAME AND ADDRESS (If different than charge to):

MAIL TO:
Mitchell Wholesale
P.O. Box 208
Valley Falls, New York 12185

Email: info@versatile-contents.com