AmazonMoosey's Ambit. Printable Order Form:
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Please see www.amazonmoosey.com for further products and information.
Please ensure all fields are completed before sending this form to us.
Your information is never sold, traded or given away and only used to 
expedite your order.

TO:                                      FROM:
AmazonMoosey's Ambit        Name: _________________________________
C/o Gail Webber
402 Carpenter St.
Utica,Ms.  39175

(253)678-6473 VoiceMail    Address: _________________________________

                               City: _________________________________

                    State, ZIP Code: _____________________________

Today's                     Country: _____________________________
date: ___________________

Daytime
Phone #: _________________________  FAX #: ___________________________

E-mail:___________________________


ITEM Part #    Item Description             Price ea       x Qty  = Line Total 
If Known        

........  .................................... $ ______  x ___      $______
  
........  .................................... $ ______  x ___      $______

........  .................................... $ ______  x ___      $______

........  .................................... $ ______  x ___      $______

........  .................................... $ ______  x ___      $______

........  .................................... $ ______  x ___      $______


Based on the Packaged Weight
Destination Address and Zip                     S&H Fees            $______


		TOTAL ENCLOSED US FUNDS              USD Funds ONLY $______



If an overpayment of S&H or of the order is made, the difference will be refunded
to you or credited to your account.  You will be contacted.  If an underpayment 
of S&H or of the order is made, you will be contacted regarding  payment of the 
difference or a deletion of an item.

USD Funds Only.  We accept Money Orders, Cashier's Checks, PayPal, Wire Transfers, 
Visa, MasterCard, American Express. Perosnal Checks from within the US only.
Personal Checks held for 10 business days before shipping.

All fields must be completed by the customer

Check or Money Order # _______________________

Paypal _____		Money Wire _____

IF by PayPal: email address if different than above:__________________________

If payment by Credit card:   Expiration Date ______________

Card Number _________________________________________________________

Card Holder's Name (as it appears on card) __________________________

Card Holder's Signature ____________________________________

Card Holder's Billing Address if different from Shipping Address above:

Name: _________________________________

Address: _________________________________

City: ______________________________State_______

ZIP Code: _________Province______________Country: _________