JRCarri.com









**You may use this form to order if you prefer to use a check or money
order, otherwise please use the "Buy Now" button on the left.  Thanks**

405 North 8th    Alpine, Texas    79830    432-386-7191
Order Form (please print page, fill it out and mail along with your check or money order)

Date: _____ / _______ / ________

Name:__________________________________________

Shipping Address: ________________________________________

City: _____________________State:__________Zip:__________

Ph#:_____________________________

Quantity of Seats:_______ @ $45.00 each,
plus $8.00 Shipping

Total Enclosed:_________
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US Pat. 6139098