TITLE
O r d e r F o r m

Complete & fax this form to:
All Seafood  673 S. Eastwood Drive Woodstock, IL 60098
Phone  (815) 337-4028      Fax  (815) 337-4029

Ship To: Bill To:
Name ________________________ Name ________________________
Address 1 ________________________ Address 1 ________________________
Address 2 ________________________ Address 2 ________________________
City ________________________ City ________________________
State ________________________ State ________________________
Zip Code _________________ Zip Code _________________
Phone ________________________ Phone ________________________
E-mail ________________________ E-mail ________________________

Item # Product Description Weight Price Qty Extended Price
           
           
           
           
           
           
Subtotal    
Shipping    
Add Tax   (Il residents add 7%)  

Order Total

    


Payment Type  (check one please)     ____Check Enclosed   ____Credit Card  
(Please allow additional shipment time when paying by check.)
Circle One:                  Discover        Visa        Mastercard        AMEX        Credit Cards
Cardholders Name ____________________________________
Credit Card # __________________ Exp. Date ____________________