*Please print, fill out and fax or mail back.                                                
    
                                                      
William Carl Bell
                       Order Form  
                                              

                                                          
 510 Lakewood Drive                              
                         Sumter, South Carolina 29150                      
          Phone: (803) 481-0884       Fax: (803) 481-0854
                                   
                                                  
 Date of Order:                                       

Name:                                                                                              
                                          
Address:                                                                                                                                   

City:                                                     State:                               Zip:                                                                
     
Phone Number:                                                    Email Address:                                               
                                          
   
 Item Name                Quantity                   Price
         (Ex. "Stately Trio")                                                

                                                                                                                                                                        
                                                                                                                                                         
                                                                                                                                                                         

                                                       
                                                                                                                  

                                                       
                                                                                                                  

                                                       
                                                                                                                  

                                                       
                                                                                                                  

                                                       
                                                                                                                  

                                                        
                                                                                                                 

                                                        
                                                                                                                 
                                        
                                                                                            Merchandise                  
                                    
 We gladly accept the following                        Shipping (Please call)                                                        
                 credit cards                                                             Sub Total                  
                                    
                                                                                                            Tax                                                       
                                                                                           AMOUNT DUE                                                         




Credit Card  
                                                                    Expiration Date                                                    

Account #                                                                         Signature                                                               
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