Print this form to place an order
Please note: We will ship only ONE Sample Set to an address.

 

Order#	Qty	Price Each	Item Total		Ordered By:
_______	____	$_______	$_______		___________________________________ Name
_______	____	$_______	$_______		___________________________________ Address
_______	____	$_______	$_______		___________________________________ City, State ZIP
_______	____	$_______	$_______		___________________________________ Phone number, in case we have a question (Optional)
Vermont residents: 5% tax			$_______		Ship To:
Shipping (see below)			$_______		___________________________________ Name
Order Total			$_______		___________________________________ Address
Figure Product and Shipping Charges From Chart Below Order # Unit Price East of the Mississippi West of the Mississippi SP 001 002 003 004 SS1 RT1 BG001 $0.00 $35.00 $69.85 $101.00 $129.00 $229.00 $16.00 $29.00 $4.00 $8.65 $11.25 $15.00 $18.00 $32.00 $5.00 $6.00 $4.00 $10.65 $13.90 $18.00 $24.95 $48.45 $6.00 $7.00
					___________________________________ City, State
					Use your Credit Card:  __Visa  __MC __AmEx Number:_____________________________ Expiration Date: _______________________ Signature: ___________________________
All orders shipped within in 5-7 working days via US Post or UPS Ground.					Or include a check or money order and mail to: Green Mountain Blocks PO Box 146 Danville, VT 05828

Thank You For Your Order!