Your Full Name:__________________________________________________ Shipping Address:________________________________________________ City:___________________State or Province:_____________ Postal Code:__________ Country:___________ Your Phone # : ________________________ Email______________________ Name and Address as it appears on the credit card: Your Full Name:______________________________________________________ Shipping Address:____________________________________________________ City:_____________State or Province:______________ Postal Code:____________Country:____________ Your Credit Card # __________________________ Expiration Date:_______ 3 digits on back of card _______ Today’s Order Plaque Style and Color  Amount Ordered  Price Subtotal  Equus-RX    197.00   Equus-RX PRO   297.00   Hay Satchel   34.95   Hay Scale   57.95   Weight Tape   7.95   Timex Chronographer   209.00   Horse Ball   49.95   Self Weighing Scoop Plastic   59.95   1 Time Nutritional Analysis   35.00   Self Weighing Scoop Galvanize   64.95                                                          Sub Total __________________                                                          $9.95 per plaque Shipping __________________                                                                              Total __________________ Comments _________________________________________________________ Payment:  [ ] Check enclosed [ ] Money Order Enclosed (USD) Make check out to JBogs Send to: JBogdanski 27 Tanglewood Dr, Norwich CT. 06360. If you have any questions or if I can help you in any way, please drop me a note at  john@horse-memories.com or call 860-887-1581