Jumping Jacks                                        Phone:  757-638-5447                                                                                          P.O. Box 9375   Fax:  757-673-0313                                                                                 Chesapeake, VA  23321-9375 E-mail:  jumpingjacks1@cox.net                                                                           Date_________________________________ Name_______________________________________________________________________________ Address_____________________________________________________________________________ City________________________________State______________________  Zip_________      E-mail address__________________________________ Phone(     )_________________________  Item(s) Ordered            Quantity        Description                            Price       Jump Height (if req.)      Emb. Design # ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________                Color(s) of agility equipment                                           Color/Style/Size of embroidery _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Payment Method (circle one)        Cash       Money Order       Check       Credit Card    (MC/Visa/Discover/American Express) Exact name _______________________Card #___________________________Exp. Date______ Total_________ Tax_________ Shipping Charges____________ Grand Total____________ We will confirm receipt of this order via e-mail.  Due to oversize packages, shipping cannot be tallied until after the order is received.  Total price must be approved via e-mail or phone before any work is started.  ALL orders must be paid for up front and credit cards will be charged accordingly.  Approximate shipping time will also be given in the initial e-mail.  For faster service, PLEASE make sure that everything is filled out.  After completion you can mail or fax this form to us at the address and fax number listed above.
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OR CALL US AT:  757-638-5447 9:00 to 6:00 EST Monday-Saturday         ©Jumping Jacks 1/10/2001