(To return to the previous screen, use your back button)

Print 2 copies of this form, fill in your ordering information on both forms, keep 1, and mail or fax the 2nd form to:

Long Creek Mills, 108 Webb St,  Gastonia, NC 28052. - Fax Order 1-704-865-8242
http://www.longcreekmills.com   If you need more space, use the back of this form

 Name _________________________________________________________________________ 
Address ____________________________________________City___________________________ 
State _________________________Country_________________PostCode________________________ Email__________________________________________________________ 
Phone __________________________________________

Qty

Item Description

Color

Price

Total

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Sub Total:

$

                              6.5% Tax for NC residents only

Tax: 

$

TO CALCULATE SHIPPING, Ring up your order using the shopping cart on our site and then click on "CHECK OUT"
Enter your city/state and click on APPLY.
After shipping is calculated,ENTER THE SHIPPING HERE
(Then simply close your shopping cart.)

Shipping:

$

( )Check         ( )Discover ( )Mastercard.( )VISA.( )American Express

Name on card: _____________________________________ 

Card No. # _________-_________-_________-_________Exp.Date : _________

TOTAL:

$