Mail completed form with payment to:
PROUD REBEL
POB 100
FALKVILLE AL 35622
Proud Rebel Mail Order Form
Best when printed "to fit" in LANDSCAPE page orientation
http://www.proudrebel.com Email: seller@proudrebel.com

Date:____ / ____ / 2016

Page: ___ of ___

Name: ____________________________
Street: ____________________________
City: _______________ State:___ Zip:_______
Ship to (only if different): ______________________
Street: ______________________________
City:_______________ State:___ Zip:_______
Phone: ____ - ____ - ______ Ext. _____
Fax: _____ - _____ - _______
Email: _______________@__________
No Card Orders at this time
ITEM DESCRIPTION (Item numbers not used here. Just descriptions. Include sizes if needed.) QTY $ EACH $ TOTAL
1 . . . .
2 . . . .
3 . . . .
4 . . . .
6 . . . .
7 . . . .
8 . . . .
9 . . . .
10 . . . .
. SUBTOTAL $
Include 7% sales tax ONLY for deliveries INSIDE ALABAMA SALES TAX $
Plus $7 for shipping for the ENTIRE order. (There's no BS "handling charge" here!) SHIPPING $
Money orders, cashier's and official checks are not delayed. Personal checks held 10 DAYS.
Expected delivery is within 14 days after confirmed payment.
Returns for refund must be in immediately salable condition. A 20% restock fee applies.
TOTAL $