Tyless TM Fax, Mail
Order Form
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If paying by credit card, please provide Credit Card information below. MC, Visa, AMX, Discover accepted
Ship To: Bill To: (If Different)
Name: ___________________________________________ Name: _____________________________________________
Company: _________________________________________ Company: __________________________________________
Address 1: ________________________________________ Address 1: _________________________________________
Address 2: ________________________________________ Address 2: _________________________________________
City: ______________________________________________ City: _______________________________________________
State: _______ Zipcode: __________________________ State: ______ Zipcode: _____________________________
Email Address: _____________________________________ Telephone: __________________________________________
Name: ___________________________________________ Name: _____________________________________________
Company: _________________________________________ Company: __________________________________________
Address 1: ________________________________________ Address 1: _________________________________________
Address 2: ________________________________________ Address 2: _________________________________________
City: ______________________________________________ City: _______________________________________________
State: _______ Zipcode: __________________________ State: ______ Zipcode: _____________________________
Email Address: _____________________________________ Telephone: __________________________________________
Please Refer to Order Page for Colors and Sizes
Available
Available
Pricing:
No. Of Pairs $ Each S&H Total Price
1 $5.95 $1.95 $7.90
2 $5.45 $2.25 $13.15
3 $4.95 $2.55 $17.40
4 $4.95 $2.85 $22.65
5 $4.95 $2.85 $27.60
6 $4.95 $2.85 $32.55
Additional pairs may be purchased for $4.95 each with no additional
charges for shipping and handling. You may mix colors and sizes.
No. Of Pairs $ Each S&H Total Price
1 $5.95 $1.95 $7.90
2 $5.45 $2.25 $13.15
3 $4.95 $2.55 $17.40
4 $4.95 $2.85 $22.65
5 $4.95 $2.85 $27.60
6 $4.95 $2.85 $32.55
Additional pairs may be purchased for $4.95 each with no additional
charges for shipping and handling. You may mix colors and sizes.
Credit Card Number: _________________________________________________ Credit Card type: ______________
(MC, Visa, AMX, Discover)
Credit Card Expiration Date: _________________________ Fax To Tyless at: 541-344-1579
Amount Authorized: _______________________ Mail to Tyless at: Tyless
P.O. Box 11205
Eugene, OR 97440
Signature: _________________________________________
Orders with personal checks will ship after check
clears bank.
(MC, Visa, AMX, Discover)
Credit Card Expiration Date: _________________________ Fax To Tyless at: 541-344-1579
Amount Authorized: _______________________ Mail to Tyless at: Tyless
P.O. Box 11205
Eugene, OR 97440
Signature: _________________________________________
Orders with personal checks will ship after check
clears bank.