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Purchaser Information
Name
Address
City
State
Zip Code
Email Address
Phone Number
Fax Number

Credit Card Information
Credit Card Number
Credit Card Type
Credit Card Exp. Date
Name on Card
Address

Recipient Information
Same as purchaser?
Include Gift Card?
Message for gift card
Name
Address
City
State
Zip Code
Email Address
Phone Number
Fax Number

Product Name
Please list product descriptions along with quantities, sizes and colors.

Comments
Anything else you'd
like to say?

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or if you prefer you may mail us your order.

Kentucky Hemp Outfitters
1937 Richmond Drive
Louisville, KY 40205

(502) 456-6921


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