SHIPPING INFORMATION: |
| Name:___________________________________________ |
| Address:_________________________________________ |
_________________________________________________ |
| City:_____________________________________________ |
| State:__________________
Zip Code:________________ |
| Phone
Number:___________________________________ |
| E-mail:__________________________________________ |
CREDIT CARD INFORMATION: |
| Please circle credit card being used: |
| VISA |
MasterCard |
|
| CC#:____________________________________________ |
| Expiration
Date:__________________________________ |
| CVV2
Number (3 or 4 digit Card Verification Value located on back of card in signature block):
_________ |
Enter cardholder's address exactly as shown on credit card statement if
different from shipping address: |
| Name:___________________________________________ |
| Address:_________________________________________ |
_________________________________________________ |
| City:_____________________________________________ |
| State:__________________
ZipCode:_________________ |
_________________________________________________
SignatureOr Mail To: J. T.
Bowling, Inc.
400
West Midland Ave. Suite 228
Woodland
Park, Colorado 80863 |