order form table

Clearwater Hat Company Order Form -

Send your order to: Clearwater Hats, 1007 Clearwater Road, Timbo/Newnata, AR 72680

STYLE	COLOR	MEASURE/SIZE	PRICE
office use	office use	subtotal	$
PD	LS	AR Residents add 6.625%	$
BK	XTS	Shipping-per hat	$ 20.00
SP		Total	$

Name________________

METHOD OF PAYMENT: MC/VISA _______Check number_______Money Order________

MasterCard/Visa Number - Expiration Date___________ Signature___________________________

On the reverse of your credit card are some numbers usually located above the signature line.

These are usually the last four numbers of your credit card and then a three digit number ( American Express has a four digit number on the face of the card.. For added security our bank is requiring these security numbers. ______________.

Name___________________________________ Daytime phone______________________

Shipping Address_________________________City_______________________State______Zip____________

Mailing Address___________________________City______________________State_______Zip___________

Date________________E-mail_______________________