PRINTABLE ORDER FORM
 mail or fax to:
The Buffalo Head Restaurant
10626 North Lake Rd
Forest Port, NY 13338 USA
PHONE: (315) 392-6607 FAX: (315) 392-6608
1. ORDERED BY
 4. SHIP TO
Name: Name:
c/o: c/o:
Street: Street:
City: State: Zip: City: State: Zip:
Phone: Fax: Phone: Fax:
   
   
2. TELEPHONE  
In case we have a question about your order (required field)  

Day:

Evening:

  
     
3. Method of Payment  
__ MasterCard Card #: Exp:
__ Visa Print cardholder's name:
__ American Express Cardholder's signature:

(signature and telephone required for all credit card orders)
   
Item Number Color Size Qty. Description Unit Price Total
             
             
             
             
             
             
Shipping Charges:
Shipping   $
$30 and under $5 Subtotal   $
$30 - $50 $8 Local Sales Tax
(NY residents only)
   $
$50 - $75 $10
$75 - $100 $11 Grand Total   $
$100 - $150 $13
$150 - $200 $14

Please allow 7 to 10 days for delivery. No purchase will be processed without a telephone number.

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