Tyless TM Fax, Mail
Order Form
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: __________________________________________
If paying by credit card, please provide Credit Card information below. MC, Visa, AMX, Discover accepted
Credit Card Number: _________________________________________________ Credit Card type: ______________
(MC, Visa, AMX, Discover)
Credit Card Expiration Date: _________________________ Fax To Tyless at: 541-603-4974
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: 541-603-4974
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.
Pricing:
Elastic Laces $2.45 per pair
Locking Buttons $1.95 per set of 4
Shipping
First Item $1.75
Each Additional Item $0.25
Elastic Laces $2.45 per pair
Locking Buttons $1.95 per set of 4
Shipping
First Item $1.75
Each Additional Item $0.25
Locking Buttons Laces
List Color and Quantity List Color, Size and Quantity
List Color and Quantity List Color, Size and Quantity
| Lace Sizes Small = S = 25" Medium = M = 32" Large = L = 37" Extra Large = XL = 42" |