Henry County Supply - Printable Order Form

USE THIS PRINTABLE FORM FOR
MAIL ORDERING, FAX ORDERING OR PHONE ORDERS ONLY.

John Deere Authorized Dealer

Henry County Supply
PO BOX 268
HWY 421N
NEW CASTLE, KY 40050

To FAX your order
Call 502 845-1495

To PHONE your order
Call 502 845-5620

Billing Address: (Please Print) Name:_______________________________ Address:_____________________________ City:______________________State:______ Zip:_____ Phone:______________________	Shipping Address: (If Different Than Billing) Name:________________________________ Address:______________________________ City:________________________State:_____ Zip:_____Phone:________________________
EMAIL ADDRESS:________________@____________ (In case we need to contact you about your order.)

Method of Payment:
Check or Money Order: $______ enclosed
(Made payable to Henry County Supply)

Credit Card: (Check one)

Visa

Master Card

We accept
or
or

Exp. Date:__/__/__
Acct. #_______________________________
Signature:_____________________________

I have read the Policies and Shipping information.

Back Ordered Items Handling: (Check One)

Ship my back ordered items when available.
Cancel back ordered items and issue a credit.
Cancel back ordered items and issue a refund.

Date of Order:__/__/__

SAMPLE ORDER:
When ordering please fill out the form below using prefix and numbers of the item you wish to order and don't forget to note size, etc. where applicable.

Item #	Qty.	Description	add'l info (size, etc.)	Price Ea.	Total
PMXXX	2	shirt	Y--6/8	10.00	20.00

ORDER FORM:

Item #	Qty.	Description	add'l info (size, etc.)	Price Ea.	Total

USE THIS TABLE FOR Shipping/Handling Charges: (US)

Merchandise Total	Please Add for Standard Delivery
$0 -- 30.00 $30.01 -- 40.00 $40.01 -- 50.00 $50.01 -- 75.00 $75.01 -- 100.00 $100.01 -- 150.00 $150.01 -- 200.00 $200.01 -- & above	$8.95 $9.95 $10.95 $11.95 $12.95 $13.95 $14.95 $15.95

Prices subject to change without notice.

SUBTOTAL:

Less Disc.:

KY Residents
must add 6% sales tax
(Excluding food products)

ship/handling:

TOTAL:

* For Next Day Air, 2nd Day Air, or International Delivery, please call or email for prices.
** RETURN POLICY: Moneyback guarantee within 15 days of purchase w/receipt. Shipping charges are not refundable.

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