Tyless TM Mail
Order Form
                         Ship To:                                                                                        Bill To: (If Different)


Name:
  ___________________________________________    Name:  _____________________________________________



Company:  _________________________________________ Company:  __________________________________________



Address 1:  ________________________________________   Address 1:  _________________________________________



Address 2:  ________________________________________    Address 2:  _________________________________________



City:  ______________________________________________ City:  _______________________________________________



State:  
_______       Zipcode:  __________________________  State:  ______      Zipcode:  _____________________________



Email Address:  ___________________________________   Telephone:  
__________________________________________   
                      
If paying by credit card, please provide Credit Card information below.  MC, Visa, AMX, Discover accepted
Credit Card Number:  _________________________________________________                 Credit Card type:  ______________       
                                                                                                                                                     (MC, Visa, AMX, Discover)  
       


Credit Card Expiration Date:  _________________________                                Fax To Tyless at:  541-344-1579



Amount Authorized:   _______________________                                                  Mail to Tyless at:    Tyless
                                                                                                                                      P.O. Box 11205
                                                                                                                                      Eugene, OR  97440  
  

Signature:  _________________________________________

                                                                                                                        Orders with personal checks will ship after check
                                                                                                                                                          clears
bank.                                                             
                                 Pricing:

No. of Feet         Price                 S&H                    Total Price

20                  $5.50                $2.00                        $7.50

50                 $10.00               $2.60                       $12.60

100                $16.00               $4.25                       $20.25

300                $33.00               $7.50                       $40.50             

*Mix and Match colors and Lengths, minimum 5 feet per color
   
   
   
   
Total Length
 
Color                      Length