Order Form
(Please Print)		 Pine Island Primitives
16369 County 11 Blvd.
Pine Island, MN 55963
507-356-2908
 rugs@pitel.net
Mailing Address:
Name:
Address:                                                                                        
City:                                                                State:                        Zip:
Phone:                                                             Email:

Payment Method: (Check One) US DOLLARS ONLY

___ Check                 ___ Money Order                   ___ Credit Card
Card Number:  _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp. Date: _ _ / _ _
Name on Card:   Last 3 Digits on back - _ _ _

If paying by check or MO please make to: Pine Island Primitives
Catalog - $8.00 postage paid

 Quantity  Description  Price  Total
       
       
       
       
       
       
       
       
       
       
       

Shipping & Handling:
Under $50 - $6.00
$50 to $100 add $8
$100 and up add $12

Subtotal

  

Tax 6.5% (MN only)

 
Shipping  
Balance Due  

Thank you for your order. We appreciate your business.
All prices listed are in US dollars. Please be certain of your purchase. All sales final.