The order form is a method for customers to order directly off the web. Please, print out this form and either fax it to our office at 208-528-9484 or mail it to:

Belnap & Company Order Form

The item you would like to order is a:

____________________________________________

The item number of the product

___________________________________

Method of Payment:

Cash ____ Check _____ Credit Card________________________

Please write your personal information here as appears on your card:

Name: _____________________________________

Address: ___________________________________

___________________________________________

Phone: ______________________

Would you like us to send your purchase here?

Yes No (please put address below)

Name: _____________________________________

Address: ___________________________________

___________________________________________

Phone: ______________________

Please print out and fax this form to: (208) 528-9484