YOUR CABIN CONNECTION
Fax 765-474-9517
Mail: 3236 Hendrickson Lane, Lafayette, IN 47909
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Billing Address Shipping Address (if different)
Name: ___________________________ Name:______________________________
Address: ________________________ Address: ____________________________
City : _____________________________ City: ____________________________
State: ______________Zip:___________ State: ____________Zip:_______________
Phone Number: ____________________ Phone Number: ________________________
E-Mail Address: ____________________ E-Mail Address: _______________________
Item No. Item Description Quantity Color/Size Item Cost Total
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SUBTOTAL _______
*See item shipping charges online or call for charges SHIPPING _______
Orders over $75 are FREE SHIPPING
TOTAL ________
Payment Method: ____PAYPAL
__Mastercard ___Visa ___Discover ___American Express ___Cashiers Check/Money Order
Credit Card # ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Expiration Date: MM-YY __ __-__ __ Verification Code (3 digits on back) __ __ __
Name on card _________________________ Signature __________________________
