Name:
___________________________________________________________
Address:
_________________________________________________________
City: __________________________________ State :_____ Zip:
_____________
Phone: (______)__________________ E-mail:
___________________________
Check _____ or money order _____ payable to:
Jackstuff.com, or
Credit card: #______________________________ expiration date:
_________
Cardholder's name on card, if different from above
____________________________
Mail orders - send form to: Jackstuff.com, 811 Shoemaker
Rd., Webster, NY 14580
Phone orders - (585) 787-1750 |