ORDER FORM

Name: ______________________________________   Address: ___________________________________________

City: _____________________________   State/Prov: ______________________   Zip/Postal Code: ______________

Country: _________________   Day Phone: (______) _______________   Evening Phone: (______) _______________

Email:  __________________________________________________________________________________________

HOLSTER DETAILS (please fill in all areas that apply for your purchase).

Holster Model: ______________   Color: ______________   Belt Model: ______________   Color: ______________

Gun Type: ______________   Caliber: ______________   Barrel Length: ______________
    □ Right Hand Draw           □ Left Hand Draw   [Please check one or the other] 

Hip Size (holster): ______________ (where you will wear the holster, USE TAPE MEASURE!)

Waist Size (dress belt): ______________ (please supply your pant waist size)

Leg Size: (Fast Draw Only) ______________ (measure around the leg half way between crotch and knee.
                                                                   USE TAPE MEASURE)

Single or Double thickness (Dress Belts only):  ______________

Additional Details:   ________________________________________________________________________________

_________________________________________________________________________________________________


Billing Information -   ALL ORDERS PAYABLE IN U.S. FUNDS.
Cost of all orders: __________     Shipping & Handling: __________     Total $: __________

United Parcel Service UPS "GROUND"
Ground UPS Small package up to 3 pounds: $15.00
Ground UPS Large package up to 10 pounds: $20.00
These rates noted above are for ground service which averages
7 days and is trackable.		 United Parcel Service UPS "3 day"
3 day UPS Small package up to 3 pounds: $20.00
3 day UPS Large package up to 6 pounds: $25.00
3 day UPS Large package over 6 pounds:  Call for Quote
United States Postal Service (USPS)
Ground service only with an average 8 day delivery.
    This service is non trackable.
Small package: $12.00.  Large package: $18.00

If ordering more that one item at a time please ask for shipping rates.

__ Cheque enclosed / __ Money Order enclosed / __ MasterCard / __ Visa / __ AMX / __Discover



Card # ______ ______ ______ ______    3 digit number on back of card ___ ___ ___ Expiration Date (mmyy): _________

4 digit number on back of card AMX ___ ___ ___ ___

Name exactly as on card: _________________________________________

Other Comments:   __________________________________________________________________________________

 ___________________________________________________________________________________________________
Mernickle Custom Holsters     1875 View Court      Fernley, Nevada    USA   89408