Kentucky Barrels LLC

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

For more information email: kybarrels@windstream.net  or call: (606)346-0887
 fax (606) 773-0401
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 1684
Danville, KY 40423-1684
                           When you are finished printing, use the "back" function of your browser to return to the last page viewed.
Card Type:  Visa:________  Master Card:________  American Express:________  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
_______ _______ _________
______________________
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_______ _______ _________ ______________________ ______________ _________ __________
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_______ _______ _________ ______________________ ______________ _________ __________




SUBTOTAL
_________ __________




KY RESIDENTS AD 6% SALES TAX

 
 

_________


 
 

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


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