WHITEHOUSE SADDLE PADS
403 Ball Street ~ Marietta, OK. 73448
Phone 580-276-4441  Fax 580-276-9774

ORDER FORM

Qty.

Blanket Name

Item#

Blanket Type

Price

______ _______________ _______________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 175.00
$ 180.00
$ 185.00
$ 190.00
         
______ _________________ __________________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 175.00
$ 180.00
$ 185.00
$ 190.00
         
______ _________________ __________________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 175.00
$ 180.00
$ 185.00
$ 190.00

Shipping UPS & Handling Charges:
1 Blanket  $14.00
2 Blankets $18.00
3 Blankets $22.00
4 or more call for quote

Method of Payment:

_____Enclosed check
_____Please Charge my _____Master Card _____Visa _____AmExpress _____Discover

Charge card number:_________________________ Exp. Date_____________  CSC___________

Charge cart in the name of:__________________________________________________________

Ship to:

Name:__________________________________________ Telephone:________________________

Address:_____________________________ City:_______________ State:_________ Zip:________

                                                       Signature:_____________________________________