The NorEsta Cane & Reed Fax / Surface Mail ORDER FORM
NAME  
CHECK
MONEY ORDER
CREDIT CARD*
STREET   Credit Card Number and CVN:
APT #    
CITY   Expiration Date:  
STATE   Special Instructions:
ZIP CODE    
PHONE  
FAX  
EMAIL  
ITEM CODE
ITEM DESCRIPTION
QUANTITY
PRICE
AMOUNT
         
         
         
         
         
         
         
         
         
         
         
         
      SUB TOTAL $
      SALES TAX 6% Michigan Residents  
      Shipping  
      Handling Fee $3.00
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Print this order form. Mail with payment to The NorEsta Cane & Reed 329 Water St., Allegan MI 49010
Or Fax to 269-673-7372. Thank you for your order.
Toll free telephone number: 1-800-NORESTA (667-3782) Email: sales@noresta.com
 
*We are asked to have the 3 digit Credit Card Verification number along with your 16 digit number. You will find this 3 digit security number on the back of your credit card. Please include this information when you place your order. Thank you.