printable order form
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to pay with Paypal
If you would like to mail or fax your order, you are welcome to PRINT out
this form to use. Make Checks
payable to: MTCo
Available 24 hours, our Toll Free FAX number is:
(866) 224-4628
Our mailing address is: MTCo / P.O. Box 667 / Pineville MO 64856
| Full name: | Email: |
| Street/shipping address: | |
| City: State: Zip: | |
| Day Phone: | Evening Phone: |
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Circle card type please: Visa MasterCard Discover American Express |
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| Card#________-________-________-________ | Expiration Month ___________Year______ |
| IF different from above, please give name on card, billing address and signature. | |
| Name: |
Address: |
| City/State/Zip: |
Signature of card
holder: |
| Qty | Item # (if available) | Item Description | Item Price | Extended Amount |
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Missouri Residents only, please add sales tax 7.75% |
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Shipping. If cost is not listed
with the item, we ship best way. We combine multiple items to save you cost.
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Page last updated December 27, 2007 |
Grand Total |
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