PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO:

Clear Creek Mercantile
131 N. Pitt
Virginia, Illinois
United States  62691
Phone #: 217-452-3126
Fax #:
Email: marcia@clearcreekmercantile.com

Circle Payment Method:          Check    Money Order            

  Print Name:
  Address:   Email:
  City:    
  State & Zip:    
  Telephone:   Signature:_____________________

Item Name and Description

Quantity

Price
     
     
     
     
     
     
     
     
     
     
     
     
     
 
    

Subtotal:  

    

Shipping and Handling:  

    
Illinois residents must add 6 1/4% sales tax-   
    

MAKE CHECKS PAYABLE TO: Clear Creek Mercantile  

Total :

 


Thank you for shopping at Clear Creek Mercantile.