Tyless TM Fax, Mail
Order Form
Lace Size
Lace Color
Button Color
Quantity
       
       
       
       
If paying by credit card, please provide Credit Card information below.  MC, Visa, AMX, Discover accepted
                       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:  
__________________________________________   
                      
Please Refer to Order Page for Colors and Sizes   
            Available
                               Pricing:

No. Of Pairs        $ Each                S&H                    Total Price

1                   $5.95                 $1.95                       $7.90
2                   $5.45                 $2.25                      $13.15
3                   $4.95                 $2.55                      $17.40
4                   $4.95                 $2.85                      $22.65
5                   $4.95                 $2.85                      $27.60
6                   $4.95                 $2.85                      $32.55     

Additional pairs may be purchased for $4.95 each with no additional
charges for shipping and handling.  You may mix colors and sizes.
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.