Mail completed order form to: PURCHASE ORDER

J5 Enterprises

Home Of The Dryer Shoe Holder

P.O. Box 237163

Cocoa, Fl 32923-7163

Customer Name: Ship Name:

Billing Address: To Address:

City, St., Zip: City, St., Zip:

Phone: Phone:

ORDER DATE	PURCHASE ORDER #	CUSTOMER ORDER #
	(Office Use Only)	(Office Use Only)

QUANITY	DESCRIPTION	UNIT PRICE	COLOR	LINE TOTAL
	DRYER SHOE HOLDER	$19.95	BLUE OR WHITE
				SUBTOTAL:$
				SALES TAX:$
				SHIP. & HAND. $5.00
				TOTAL:$

Payment Terms: Check, Money Order, No C.O.D.’s

Please add sales tax according to your state.

Blue Dryer Shoe Holder Will Be Available For Limited Time

Allow 2-4 Weeks for Delivery