Coughlin's Order Blank

< Coughlin's Order Blank

Coughlin's Order Blank

All blanks with an * MUST be filled in for your order to be honored. We think to highly of our customers to sell or let anyone have our mailing lists or the phone numbers of our customers. We use encryption 128 Thank You.

To use this form, type information in the blank and tab to next blank, all the way thru the form.

*First Name: Middle Initial: *Last Name: *E-mail Addr: Company: *Mailing Address: Address: Address: *City: *State: *Zip Code: *Country: Country Code: *Home Phone: Home Fax: Work Phone: Work Fax:


Please list below the sale or Special Offer # you are ordering from Example: Store item # (located under the illustration) (SPO#1 (SPO for special Offer). Please type as shown, I am Ordering from: Lot Numbers:

Comments:


We Accept only Pay Pal ot checks or Noney Orders.

6ccards

"I AUTHORIZE COUGHLIN'S TO PROCESS MY INTERNET ORDER FROM _________(PRIVATE TREATY OR SPECIAL OFFER # IN THE BLANK) ON MY Pay Pal account, and a Pay Pal payment request for which we will send you an invoice.

The Letter or Postcard authorizing the sale MUST be signed and have your address on it also.

Telepoone

Our Land Line # is:

870-376-4520

snailml

Our snail mail address is:
6250 Painted Canyon Drive, Apt. 2101
Fortb Worth TX 76131-2426
72653-4179

Please check your order. If it is OK, click the Submit Order button.
The "Clear Form" button will clear the data in the form making it blank again allowing you to retype the data needed into the form.

(submit this order) (clear this order)


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Last Update: 08/29/2005
Web Author: Ray L. Coughlin
Copyright 2005 by Coughlin's - ALL RIGHTS RESERVED


Table Of ContentsE-Mail
Table of Contents Send E-Mail

Last Update: 01/31/2017
Web Author: Ray L. Coughlin
Copyright 2017 by Coughlin's - ALL RIGHTS RESERVED