Mail In Credit Card Order Form

Mail in Credit Card Order Form Visa, Master Card, or Discover Card

For more information email: kybarrelquote@gmail.com or call: 606-282-0921

TO ORDER:

Before you order make sure read and understand our sales terms. By placing an order you agree to our sales terms. Click here to read terms

Please print this page using the "print" function on your browser, fill it out, and send it along with check or money order to:

mail to:

Kentucky Barrels
PO Box 474 - Junction City, KY 40440
When you are finished printing, use the "back" function of your browser to return to the last page viewed.

Card Type: Visa:________ Master Card:________ Discover Card:________

CARD NUMBER:__________________________________________________________________________

Expiration Date:______________________ CVV2::____________________
CVV2 is a 3-digit number at the end of the credit card number on the signature panel on the back of the credit card, and 4 digits on the front of an American Express card

NAME Of CARD HOLDER:____________________________________________________________________________________

ADDRESS OF CARD HOLDER:

Street:____________________________________________________________________________________________________

City: ____________________________________________________________________________________________________

State: _____________________ Zip Code:___________________

SHIP TO (if different from above)

       Business Name:_____________________________________________________________________________________________

       Street:_____________________________________________________________________________________________________

       City:   _____________________________________________________________________________________________________

       State: _____________________   Zip Code:___________________

PHONE:____________________________ EMAIL ADDRESS: ________________________________________________________

I have read and agree to Kentucky Barrel ordering terms, sign here:_________________________________________

Please send me

QTY	ITEM	UNITS	DESCRIPTION	UNIT PRICE	SHIPPING	TOTAL
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
_______	_______	_________	______________________	______________	_________	__________
				SUBTOTAL	_________	__________
				KY RESIDENTS AD 6% SALES TAX	_________	__________
				TOTAL	_________	__________

By placing an order you agree that you have read and understand our ordering terms
CLICK HERE TO READ ORDERING TERMS