C/o
Beargrass, Inc. PO
Box 142059 Spokane,
WA 99214-2059 Phone:
(509) 927-0404 Fax:
(509) 928-2392 Website:
www.huckleberrycottage.com Email:
info@huckleberrycottage.com
Customer’s Name Phone
No. Date Address
Apt. No. City
State
Zip Code
Country
Cash Check
Visa Master Card
American
Express Diner’s
Club Discover
Account
No.
Exp. Date
Customer’s Signature ____
_______________________ Quantity Price Amount
UP TO
$19.99 . . . . . . . . . . .
$6.00 $20.00 TO
$34.99 . . . . . .
$8.00 $35.00
TO
$39.99 . . . . . .
$10.00 $40.00
TO
$59.99 . . . . . .
$12.00 $60.00 TO
$79.99. . . . . .
$14.00 $80.00 TO
$124.99. . . . .
$16.00 $125.00 and up .
. . . . . . . . . .
$18.00 Next Day or Rush Orders please add $16.00 to order International Orders Add $10.00 International Rush Delivery Please Add $20.00 Please
send me ______ additional Order Blanks Merchandise Total $ Shipping and Handling $ Subtotal $ WA State Residents please add applicable sales tax of 8.1% $ Subtract any discounts, credits or certificates Net Amount Due $
Huckleberry Cottage

Description
No Charge