Use this order form for phone, fax and mail orders... For credit card phone orders, call us at (812)887-2141
Mail your order to:

Beauty for Ashes Chimney Sweep Service
829 N. 5th. St.
Vincennes, IN. 47591
Fax your order:
Not Available ... Yet!

Phone your order:
(812)887-2141 ... Anytime!
LEAVE US A CALL-BACK PHONE NUMBER

Bill To ( as it appears on credit card or check ) Ship To ( if different than bill to information )
Name


Name
Company


Suite/Floor Company Suite/Floor
Address


Apt. No. Address Apt. No.
City, State


Zip City, State Zip
Daytime Phone No.  (     ) Daytime Phone No.  (     )
Email Address   Email Address  

Payment Method

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Credit Card Number
Expiration Date
 

Signature

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(required for credit card payments)


Item Number Color / Finish Description Qty Unit Price Total
           
           
           
           
           
Merchandise Total  
(IN residents add 7.00%) Sales Tax  
(Use the Online CHECKOUT Calculation here) Shipping & Handling  
ORDER TOTAL