Dixie Depot Mail Order Form

For your convenience, we include the following form that you can print out and mail or FAX to Dixie Depot.

Shipping Address:
Name: _____________________________  Street: _____________________________

City: __________________________ State/ Province :____________ Zip Code: _______

Country: ______ Phone: (____)________________E-Mail ________________________

Catalog # ______ Des. ______________________Quant.____ Price ea. ____Tot $_______

Catalog # ______ Des._______________________Quant.____ Price ea______Tot $______

Catalog # ______ Des. ______________________ Quant._____Price ea.______Tot $_____

Catalog # ______Des._______________________ Quant._____ Price ea _____Tot $_____

Catalog # ______ Des._______________________Quant._____ Price ea______Tot $ ____

Catalog # ______ Des._______________________Quant._____ Price ea.______Tot $____

Catalog # ______ Des._______________________Quant._____ Price ea.______Tot $____

Catalog # ______ Des._______________________Quant._____ Price ea ______Tot $____
Note: for international S&H, E-Mail for amount.           Merchandise amount due $_________
                                                              Plus Shipping & Handling U.S.A. $5.00
                                                                              Total amount ------------ $_______
                                                                Georgia Residents add 7% Sales Tax --$________
                                                                                Total aount due ------------ $________
Credit Card (_) or Check (_).  VISA(_) Master Card(_) Discover (_)
Card # _______________________________________ Exp. Date ______
Your Signature _______________________________E-Mail ______________________
Make checks payable to Dixie Depot.
Mail to: Dixie Depot, P.O. Box 1448, Dawsonville, GA 30534
FAX to: 1-404-257-1992, Call orders for $20.00 or more to 1-800-942-2447
Note: Include Address on your credit card if different from the shipping address above.
Name:_____________________, Street: _______________________
City: _______________________ State/ Province: _________________ Zip: ________
Country: ___________________