Order Form

General Jim's Surplus Order Form

Please complete this form, print it out and mail to:
General Jim's Surplus
8810 S. Clare Ave.
Clare, MI 48617
Or: Call your order in (517) 386-5425

Please provide the following ordering information
and make sure all of the appropriate lines are filled in

QTY DESCRIPTION

BILLING

Credit card

Cardholder name

Card number

Expiration date

CARDHOLDER ADDRESS

Street address

City

State/Province

Zip/Postal code

Phone

PLEASE SPECIFY IF YOU WOULD LIKE THE ORDER TO BE SHIPPED TO A DIFFERENT ADDRESS THAN THE ONE PROVIDED.

	BILLING
Credit card
Cardholder name
Card number
Expiration date

	CARDHOLDER ADDRESS
Street address
City
State/Province
Zip/Postal code
Phone