dubyah logo www.bushgnome.com


Please print this form and return it via U.S. Mail.
See the bottom of this page for our mailing address.

our product
Bush Gnome 4.0
Bush Gnome 3.0 + stump
Traditional Gnome 2.0A
Patriotic Gnome 2.0B
Military Gnome 2.0C
M-16 Gun Accessory

our price
$34.95
$34.95
$29.95
$29.95
$29.95
$2.95

quantity
x ______
x ______
x ______
x ______
x ______
x ______

total
= _______
= _______
= _______
= _______
= _______
= _______

 

Ohio residents please add 6.00% sales tax

_____
 
Shipping and Handling (any size order) $9.95  

(Orders outside of the U.S. please
add an additional $10 USD )

   
Total Amount Enclosed ________  
 
Shipping Address Information  
Your name _____________________________________________________________________
Address _____________________________________________________________________
  _____________________________________________________________________
City ____________________ State________________ Zip Code__________________
Country ____________________ Phone #_____________ email _____________________
 
 
Please mail this order form to : Sam Girton
20 Elmwood Place
Athens, OH 45701
 

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