(Print this Order Form and mail with check or money-order to:)
White River Source
3645 E. Main St. #176
Richmond, IN  47374
Date:
Purchased by Name:

Address:	Ship to:
address:	(if different):

Phone:
email:
Other instructions:
 

Product Description	Quantity	Catalog number	Unit Price	Line Total
Total from attached sheet (if more)	---	--------	---------
SHIPPING & HANDLING	---	--------	---------
Indiana residents add 6% tax	---	--------	---------
TOTAL	---	--------	---------

Total Order Amount (before tax)	Add this amount for Shipping and Handling
$0.01 - $49.99	$15.00
$50.00 - $99.99	$20.00
$100.00 - $299.99	$25.00
$300.00 - up	(above $300 get quote)