Catalog Number

Description/Title

Qty

Price

Total
Price

Merchandise Total

Taxable Subtotal

Add Tax (for delivery in FL only)

Total

Name:

Ship to:

Street Address:

City:

State:

Zip:

Daytime Phone:

Alternate Phone:

Ship by: (check one)
FedEx Overnight 11am
FedEx Standard 5 pm
FedEx 2-day
UPS Surface
Priority Mail
Other _______________________

Method of Payment:
Check or Money Order enclosed and payable to Bluewater Books & Charts.
Charge to:
Visa
MasterCard
Discover
Amex

Name on Card:____________________
Card No: ________________________
Exp. Date:_______________________
Signature:_______________________