St. Pierre Apparel & Video Order Form

Ship to:
Name
Address
City
State
Zip Code
Daytime Telephone #
Bill to: (If different from Ship to:)
Name
Address
City
State
Zip Code

Model #	Color	Size	Qty	Description	Total Price

Sub Total
5% Sales Tax (Only for Video when shipping to MA Residents)
Shipping & Handling Charges (From Chart)
Grand Total

Method of Payment
Check or Money Order Enclosed
Payable to: St.Pierre Manufacturing Corp. (US Funds)