SERVANT QUARTERS
P.O. Box 219
Cathedral City, CA 92235
Office: 1 (760) 321-0077
Toll Free Order: 1 (888) 321-0077
Fax: 1 (760) 202-1139
Please Print Clearly, Thank You !
I WISH TO ORDER:
Item #: _____ Description: ___________________ Quantity ____ Size: _____ Price: $_______
Item #: _____ Description: ___________________ Quantity ____ Size: _____ Price: $_______
Item #: _____ Description: ___________________ Quantity ____ Size: _____ Price: $_______
Item #: _____ Description: ___________________ Quantity ____ Size: _____ Price: $_______
Item #: _____ Description: ___________________ Quantity ____ Size: _____ Price: $_______
Total Amount Of My Order Is: $__________________
PAYMENT:
VISA: ___ Mastercard: ___ Discover: ___ American Express: ___ Check:___ Please Bill Me: ___
Name On Credit Card: __________________________ Signature: ________________________
Credit Card Number:________________________________ Expiration Date:________________
MAIL ITEMS TO:
Name:_______________________________________________________
Address:____________________________________________________
City:________________________________________________________
State:__________ ZIP:__________________
Phone: (______) ________________________
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