Mail order form to:
The Silver Mesa
PO Box 11616
Prescott, AZ  86304

FAX or Phone to charge your order:
FAX: 1-928-778-4457  (24 hours, every day)
Phone: 1-800-743-3103 (limited hours; best time
9AM-5PM CST, Mon-Fri)
  
Ordered by:

Name ______________________________
Address ____________________________
___________________________________
City________________________________ State__________ Zip Code_____________

 Ship to:  (Only if different from "Ordered by")

Name ______________________________
Address ____________________________
___________________________________
City________________________________ State__________ Zip Code_____________
Daytime phone (       )______________ Evenings (       )__________________  Ask for ______________
Item Number Description

Qty

Total
. . .  $
. . .  $
. . .  $
. . .  $
. . .  $
. . .  $
. . .  $
Method of
Payment:
All prices stated in
US dollars.

__Charge to my
     (circle one)
     Visa
     MasterCard

__Check or Money
     Order enclosed
   (US funds only)

 Please include credit card numbers and
expiration date with charge orders!

        |_|_|_|_|-|_|_|_|_|-|_|_|_|_|

Expiration Date:  ___/___  (Month/Year)

X_______________________________
      Signature (as shown on credit card)
Total price of items .
UPS Ground*

7.00
UPS 3-Day*   Add $3.00 .
UPS 2-Day*   Add $7.00 .
Total .
AZ residents add 6.5% .
Total AZ residents .

*Shipping charges for each address: continental USA only.  Call or e-mail for rates to other areas of the world.