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SAMSON® MONSTER TRUCK
MERCHANDISE ORDER FORM

To Order by Mail, please provide the following information

ITEM SIZE QUANTITY PRICE TOTAL
         
         
         
         
         
         

Shipping & Handling Charges
$25 or Less   $ 7.00
$26 - $50   $ 9.00
$51 - $75   $11.00
$76 - $100   $13.00

Subtotal  
State Sales Tax
Ohio ONLY - 7%
  
Shipping/Handling  
ORDER TOTAL  

NAME
  
ADDRESS
  
CITY
  
STATE
  
ZIP CODE
 
PHONE
  

You can pay by CHECK, MONEY ORDER or CREDIT CARD to:
Patrick Enterprises, Inc.

Mail your order to:
Patrick Enterprises, Inc.
8564 Zane Trail Rd.
Circleville, Ohio 43113

Credit Card Info:
Visa, Mastercard, Discover, or American Express #__________________ Exp. Date _______

Allow 2 - 4 weeks for delivery
www.samson4x4.com

For Questions Or More Infomation, Contact Us
Thank-you!

Samson Monster Truck Racing Patrick Enterprises Monster Truck Chassis Building, Construction, Fabrication and Components, Photos, Merchandise


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