WHITEHOUSE SADDLEPADS
 403 Ball Street, Marietta Ok. 73448
580-276-4441

ORDER FORM

Qty.

Blanket Name

Item#

Blanket Type

Price

______ _______________ _______________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 160.00
$ 180.00
$ 185.00
$ 190.00
         
______ _________________ __________________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 160.00
$ 185.00
$ 185.00
$ 190.00
         
______ _________________ __________________
______Reiner, no filler
______Performance, 1 filler
______Performance, 2 filler
______Roper, 3 filler
$ 160.00
$ 180.00
$ 185.00
$ 190.00

Shipping UPS & Handling Charges:
1 Blanket  $18.00
2 Blankets $22.00
3 Blankets $26.00
4 or more call for quote

Method of Payment:
_____Enclosed Check
_____Please Charge My _____Master Card   _____Visa   ______Am Express   _____Discover

Charge Card Number:_________________________ Exp. Date____________________
Code On Back Of Card:________________________
Charge Cart In The Name  Of:________________________________________________

Ship to:
Name:__________________________________________ Telephone:________________________
Address:_____________________________ City:_______________ State:_________ Zip:________
Email:____________________________________

                                                       Signature:__________________________________