Mail or Fax
Order Form

This is a printable order form that may be mailed or faxed. Please print clearly and fill in the form completely in order to assure prompt delivery. 

How To Print And Use This Form

In the "FILE" menu of your Browser - CHOOSE PRINT.

Fill in the form and total the items

 

_________________________________________________________________________________
Name ( please print clearly)

 

_________________________________________________________________________________
Address


_________________________________________________________________________________
City State ZIP


_________________________________________________________________________________
Daytime Phone Number - Area code & Number


Check / Money Order _________________ VISA _______________ MasterCard ___________


___________ / ___________ /___________ /___________
Card Number


_________________________________________________________________________________
Exp. Date Signature


_________________________________________________________________________________
Name On Card


QNTY ITEM# ITEM DESCRIPTION PRICE EACH SUBTOTAL
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________
_______ ______________ ___________________________________ _____________ __________________

 

Shipping & Handling

Included
Total Enclosed ________________

Thank You

Our Mailing Address

Manuel Development Corporation
2531 Sandhills Dr
Cape Charles, VA 23310
Office phone: 757 331-1055

Our FAX Number

757 331-4022