Cactus Canyon

Print and MAIL This Form To:

Cactus Canyon
HCR 65 Box 3
Southard, OK 73770
1-800-836-9578 

We will add the correct shipping charge for your credit card order.

For money orders and checks, you may go part-way through the check-out process to find the total cost with shipping. Or simply email us HERE and we'll send you the exact amount.

 

Product name ................................... ...Quantity:......................

Price:.........................................................................................

Billing Address

Name:.......................................................................................

Address:............................................................................................

City:..............................................................................................

State & Country:............................................................................               

Zip code:..............................

Please include your Phone number in case we need to call you about your order.....................................................

Shipping Address (only complete if different from billing address)

Name:...................................................................................

Address:............................................................................................

City:..............................................................................................

State & Country:............................................................................               

Zip code:..............................

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Email:..............................................

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Complete the following if you wish to pay with a credit card:

Circle One: Discover, American Express,
                    MasterCard or VISA.           #   .................  .................  ............... .................

Expiration Date:     ......../........ 

 Signature:...................................................