Bouchard Unlimited Order Form

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Item #:	Item Description	Quantity:	Price
	Total
	Shipping
	Tax (MI 6%)
	Total Enclosed

Card Type	16 Digit Card Number	Expiration Date
Verification Number (from back of card)

Signature:___________________________________________________________

Please make checks or money orders out to
Megan Bouchard
Print this form and mail it to the following address:
Megan Bouchard
P. O. Box 573
Hazel Park MI 48030-0573
If you wish, you can call us during business hours (8:30 AM - 5:00 PM ET) at (248)543-2696.