Print-able Order form

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO: My Country Nest 2122 Central Avenue Kearney, NE United States 68847 Phone #: 308-698-1188 Fax #: 308-698-1188 Email: pamela@mycountrynest.com
Circle Payment Method: Check Money Order VISA MasterCard
Print Name:
Address:	Email:
City:	Credit Card Number:
State & Zip:	Expires:
Telephone:	Signature:_____________________

Item Name and Description	Quantity	Price














Subtotal:
Shipping and Handling:
NE residents must add 5.05% sales tax-
MAKE CHECKS PAYABLE TO: Pamela Robbins	Total :

Thank you for shopping at My Country Nest.