Customer Information: 
______________________________________
Name
______________________________________
Address
______________________________________
City                  State   Zip Code

(___) ____- _____  (___) ____ - ______
Home Phone          Work Phone

E-mail Address _______________________
      (For email order confirmation
Shipping Info:

Check if same as above

______________________________________
Name
______________________________________
Address
______________________________________
City                  State   Zip Code
Print Form and Mail to: 
Vaughan's Mailbox Door
260 David Larsen Dr.
Stockbridge, GA 30281
770-474-0407 (local)
1-800-337-7596
Home
Qty Description Price Total
____ 6 1/4" Rural # 1 $103.95 $________
____ 8" Rural # 1 1/2 $129.95 $________
____ _______________________________________ $______ $________
____ _______________________________________ $______ $________
Subtotal: $________
Shipping: ( $7.95 per item.) $________
Total: $________

Make Check or Money Order payable to Brian Vaughan.