XTRA TIRE Order Form

Please "Print" this page, complete and send with check or money order to:
	Two Hills, Ltd. PO Box 214 Elliott, IA 51532 Phone: (712) 767-2420
Ship to:			Phone #: E-mail :
Date Ordered	Start Ship	Completion Ship	Shipped Via	F.O.B. IOWA	Salesperson	Cust. Order No.

Quantity	Description				Unit Price	Amount
	"XTRA TIRE" spare tire mount				$34.95




All claims must be made within 5 days after receipt of goods. No returns without written authorization. We charge $25 for all returned Checks.					Iowa Residents 6% Sales Tax
					Shipping	8.50
					TOTAL	$