Vintage Scuba Supply - Dan Barringer, Owner
287 McMullen Creek Road, Selma, OR  97538  USA
dan@vintagescubasupply.com --  (541)597-4833

Print and Mail Order Form

Name: _________________________________________________
Address: _______________________________________________
City, State, Zip: _________________________________________
Phone: ________________________________________________
Email: _________________________________________________
 
 Item #
Description
Quantity
Price Ea.
Total Price
         
         
         
         
         
 
Sub-Total for all items  
Add Shipping Charges
(see chart below)		  
GRAND TOTAL  
Apply shipping charges as follows:
First pair any style hoses, $8.50, additional $3.00.
First Mouthpiece $4.75, additional $1.25
First T-shirt, $6.50, additional $2.00.
First duckbill, $2.25, additional 50 cents.
First pair mouthpiece valves, $2.75, additional 25 cents.
First pair any style clamps, $1.85, additional pair 50 cents.
First pair cages, $2.75, additional pair 50 cents.

NOTE: No additional shipping charges on duckbills, mouthpiece valves, cages, mouthpieces and/or clamps  when ordered  WITH one or more pairs of hoses.

Please make check or money order payable to:
Dan Barringer
287 McMullen Creek Road
Selma, OR  97538