PRINT AND COMPLE THIS FORM AND MAIL
TO EITHER SHIPPING LOCATIONS.

PURCHASE ORDER                     
Lady Blues
HEADQUARTERS
Attn: Linda 
P.O. Box 1162
Carson City, NV  89702
775-884-0344
Lady Blues
ATTN: Bev 
4343 Island View Drive NE
Bemidji, MN  56601

SHIP TO

__________________________________________________________________
NAME

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SHIPPING ADDRESS

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CITY      STATE  ZIPCODE

__________________________________________________________________
PHONE NUMBER

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E-MAIL

Credit Card Information
# __ __ __ __ -__ __ __ __ - __ __ __ __ - __ __ __ __     Exp Date: __ __ / __ __

Signature ________________________________________________________________________________
                                                        FOR CREDIT CARDS ONLY

We appreciate your business.  To assure fast and accurate delivery, please make sure all
information is complete and accurate.

Thank you … Linda and Bev
Lady Blues, Inc.

____ Personal Checks
____ Money Orders
____ MasterCard
____ Visa
____ PayPal

TO USE A CREDIT CARD YOUR MUST PRINT THIS FORM AND COMPLETE THE SECTION ABOVE .

Multiple orders are sent individually.
Will be shipped on the same day, but may arrive on separate days.