Order Form

To order any of our products, you can either call us at (707) 538-7485, or follow the instructions below.

Simply fill out this form, print it out, and send it to us at:
The Patrick Mint, C/O Web Department
P.O. Box 3486
Santa Rosa, CA 95402

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Billing Address:
	Name     
	Street   
	City     
	State or Province     Zip 
	Country   

Shipping address if different from above:
	NOTE: If the Shipping address is the same as the Billing address,
	just type "Same"


	Name     
	Street   
	City     
	State or Province    Zip 
	Country   



	Email    
	Phone number 


	
Please send me the following items:

      Quantity		     Description		 Amount
   1.   
   2.   
   3.   
   4.   
   5.   
   6.   
   7.   
   8.   
   9.   
   10.  

   NOTE: Shipping charges are:			       Subtotal 
   Continental U.S. $3.00			       Shipping 
   Alaska, Puerto Rico and Hawaii $5.00
							TOTAL: