Country Store
Order Form

QTYITEM #DESCRIPTIONSIZE / STYLEPRICETOTAL
           
           
           
           
           
           
Send to:
Joe McDonald
P.O. Box 7064
Berkeley, CA 94707, USA
Subtotal _______
Add $6 for shipping & handling                
($15 outside US) _______
TOTAL _______

Please print your name and address clearly so that Country Joe can read it!
Ship to: Name ________________________________________________
Street Address ________________________________________________
________________________________________________
City ________________________________________________
State/Province ________________________
Postal code ________________________
Country ________________________
 
Please inscribe item(s) to: ________________________________________________
________________________________________________

I wish to pay by:

__ Check or money order. Make payable to Joe McDonald. (We regret that we can only accept US cash and US checks due to the exorbitant fees US banks charge for handling other types. We apologize to our international customers.)

__ VISA __ Mastercard

Credit Card No. _____________________________________ Expiration Date _________

[Your credit card statement will reflect a billing to Country Joe's Country Store]