Order Form for Fax and Regular Mail

Fax: 1-800-429-8920
Mail: Cherokee Industries, P.O. Box 1787, Powell, TN 37849


Prod no. Product name Price Qty Price * Qty
______ ______________________ $_____ ___ $________
______ ______________________ $_____ ___ $________
______ ______________________ $_____ ___ $________
______ ______________________ $_____ ___ $________
______ ______________________ $_____ ___ $________
______ ______________________ $_____ ___ $________
 
  Subtotal:     $________
  Add shipping ($6 regular; $12 fast):     $________
  Total:     $________
 
Name: _________________________________
Address: _________________________________
City: _________________________________
State: ____________________
Zip: ________
Phone: ____-____-_______
Email: _________________________________
 
Payment method: Personal check / Cashier's check / Credit card
(if faxing, credit card is the only option)
 
Credit Card: VISA / Mastercard  
Credit Card Number: ___________________________
Credit Card Security Code: ________
Credit Card Expiry Date: ____/____
Exact name on Credit Card: ___________________________