Offline Ordering Form
Please print this form for mail order, allow 2-4 weeks. Call ahead for faster availability or special needs!
email at alamode@netins.net   or see phone info below:

  Quantity Item description item # Price Per Unit Price
1.          
2.          
3.          
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7.          
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11.          
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13.          
14.          
15.          
  Sub Total  
Tax - if applicable  
Shipping and Handling $10.00
Total  
SHIPPING ADDRESS:
Name: _______________________________
Address1:_____________________________
Address2:_____________________________
City:___________________
State:_______
PAYMENT METHOD:
[ ] Credit Card - Visa, Master Card, Discover
C.C. #:____________________________
Expiration Date:____/____/____
[ ] Money Order or Bank Draft
[ ] Check -Order can not ship until check clears

 

SHIP THIS FORM TO:

Country Alamode
301 Main St
Aurora, Iowa
Phone: 319-634-3822
Fax:319-634-3811