Kupango International
Serving the Community & Armed Forces Since 1995

PO Box 620236
Fort Rucker, AL 36362-0236

 Print Form

Print this Form To Order By Fax Or Regular Postal Service

 

Mail with Payment in stamped envelope to:                Mastercard/Visa Information

 Account#_______________ _____

 Exp. Date_______________                                               

 Signature____________________

Name____________________________________________________Date___________

 Address_________________________________________________________________

 City___________________________State________________Zip + 4_______________

 Phone Number ____________________   Email:_________________________________

 *FOR ANY CLOTHING ORDERS PLEASE PROVIDE HEIGHT AND WEIGHT*

 


Item

Description (full description please

QTY.

Size

Color

Unit Price

Amount

       
       
       
       
       
       
       
       
       
       
       
       
       
Subtotal______
Postage and Shipping______
______
Sales Tax Al. 8%_______
Extra Postage (i.e. for heavier items ,for Canada, overseas, and APO/FPD)_______
_______
Total_______
          Phone: (334) 598-4902