Minnetonka by Mail - Order Form

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Minnetonka By Mail                                    Phones: (718)-365-7033
P.O. Box 444                                                  (718) 364-6266
Bronx, New York 10458                                    Fax: (718) 364-6266

SOLD TO:                                 SHIP TO: (If not the same)

___________________________________      ___________________________________
Name                                     Name

___________________________________      ___________________________________
Address                                  Address

___________________________________      ___________________________________
City, State, Zip                         City, State, Zip

___________________________________      
Phone Number

|                               |        |     |     |    P  R  I  C  E    |
| Item and Style Number         |  Color |Size | QTY |   Each   |  Total   |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
|-------------------------------+--------+-----+-----+----------+----------|
|                               |        |     |     |          |          |
----------------------------------------------------------------+----------|
                                                      Sub Total |          |
                                                                |----------|
                                            Shipping & Handling |          |
                                                                |----------|
PAYMENT METHOD:                                           Total |          |
                                                                ------------
( ) Check Enclosed, Make check payable to "Minnetonka By Mail".

( ) MasterCard, Visa or Discover

    Card Number: ______________________________  Expiration Date: ___________

    Signature: ______________________________________________________________

NOTES:

Orders paid by credit cards and money orders are shipped right away - same or next day.
Orders paid by personal checks are shipped after checks are cleared - about 10 days.