Insight & Inspirations

2315 N. Wright Rd

Janesville, WI 53546

Mail Order form: Print Out and enclose check or money order

Date:_________________

Name:______________________________________________

Address_____________________________________________

City:_______________________________________________

State:____________________

Zip:_____________________

Phone:____________________

Email address:_________________________________ We will send a confirmation email

Item: Name_____________________________

Item Amount:___________________________---__________

Item: Name_____________________________

Item Amount:___________________________---__________

Item: Name_____________________________

Item Amount:___________________________---__________

Item: Name_____________________________

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Item: Name_____________________________

Item Amount:___________________________---__________

Total:_________________________________---__________

Wis. Sale Tax------.05 X total______________---__________

Shipping: Tapes--- $3.00 each _____________---__________

Shipping Chimes---$9.00 each_____________---__________

Total:_________________________________---__________