Black Mountain Stores Mail/Fax Order Form
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Name: Company: Address: City: State: Zip: Phone: Fax: EMail:	Ship To: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ (_____)___________________ (_____)___________________	Bill To: (leave blank if same) ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ (_____)___________________ (_____)___________________
Circle One: VISA MC Discover AmEx Card # __________________________________ Exp Date: _____/_____ Signature:_______________________________

Item #	Description	Unit Price US Dollars	Qty	Total








Subtotal
Shipping	(Check Below)
Total

Make check or money order payable to Black Mountain Stores, 1721 N. Texas, Odessa, TX 79761-1226. Toll free US phone order line (800)760-7942. Fax order line is (915)332-1053. We accept Visa, Mastercard, Discover & American Express. Please check shipping rates below.

FedEx Ground (US only, no Rural Routes or PO Boxes)	$5.50
Airborne 2 Business Day (US only, no Rural Routes or PO Boxes)	$12.00
US Postal Service Priority Mail (US only)	$6.00