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WNYRHS Inc. Store Order Form
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          Item  Description                                    

Quantity

   Unit Price      

 Total          
     
       
       
       
       
       
       
       
        Merchandise Total  
       NY Res. St. Tax 7  
        Total Order  

 

 Ship to : ________________________________________________________________

 Street __________________________________________________________________

 City _______________________________  State______  Zip ____________ + _______

 

               Payment Type :  Check #_____  or  M.O.   Amount Enclosed ____________

 

               Endorse and Mail to :  WNYRHS, Inc. Store

                                                       P.O Box  416

                                                       Buffalo,  New York  14231-0416

Thank you for your Order!

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