Mail completed form with payment to:
PROUD REBEL
POB 100
FALKVILLE AL 35622
Proud Rebel Mail Order Form (or phone 256_751_0175)
Best when printed "to fit" in LANDSCAPE page orientation
http://www.proudrebel.com Email: seller@proudrebel.com

Date:____ / ____ / 2017

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 4% 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 7 days after confirmed payment.
Returns for refund must be in immediately salable condition. A 20% restock fee applies.
TOTAL $