ORDER FORM

Barnacle Bill's Ship Store Order Form
Print this Order Form and Mail it in. Or you can fax it in at (574) 522-2172

Quantity	Item Number	Description	Size	Color	Price/Each	Total Cost

Shipping Charge
Order Total

Name on credit card_____________________________________________________

Address City, State Zip____________________________________________________

Credit Card NO.________________________________ EXP Date____/____

Circle which card: VISA MASTERCARD

Tell us your ship's name and hull number_________________________________________

Email Address_______________________________

Print this form. You can mail it with your Check or Money Order to:

Barnacle Bill's Ship Store
28135 W. Hively Ave
Elkhart, IN 46517.
Fax Number - (574) 522-2172

Please make checks or money orders payable to Barnacle Bill's Ship Store

Ship to address: Name:______________________________________

Street: _______________________________________

City: ___________________________ State: _____ Zip: __________

Phone: ___________________________