keenswag    O R D E R   F O R M

Website:  Http://www.keenspot.com   Email:  keenspot@keenspot.com  

DATE: ___________________________________________________________________ 

NAME: ___________________________________________________________________ 

BILLING STREET ADDRESS: __________________________________________________ 

APT #  ___________   CITY:__________________________________________________ 

STATE: ______________________________      ZIP: _____________________________ 

COUNTRY: ________________________________________________________________ 

SHIPPING STREET ADDRESS: _________________________________________________ 

APT #  ___________   CITY:___________________________________________________ 

STATE: ______________________________      ZIP: _______________________________ 

COUNTRY: __________________________________________________________________ 

PHONE NUMBER: _____________________________________________________________ 

EMAIL ADDRESS:  ____________________________________________________________ 

PAID BY CHECK:  Check # _____________________________________________________ 

NAME ON CREDIT CARD: _______________________________________________________ 

CREDIT CARD TYPE: __________________________________________________________ 

CREDIT CARD NUMBER: _______________________________________________________ 

EXPIRATION DATE: _______________________________    CSC#  ____________________ 

SIGNATURE:  ________________________________________________________________  

QUANTITY_____  ITEM NAME: ___________________________ COST __________________ 

QUANTITY_____  ITEM NAME: ___________________________ COST __________________ 

QUANTITY_____  ITEM NAME: ___________________________ COST __________________ 

                                           SHIPPING & HANDLING FEE: ________________ 

                                 South Dakota SALES TAX (4.00%):_________________ 

                                                     TOTAL DUE: __________________ 

We accept all forms of payment:  Over the Internet by PayPal and credit cards; over the phone by credit cards at 1-888-keenspot  (1-888-533-6776, toll free!); and through the mail by credit cards, checks and money orders sent to Keenspot Entertainment, P.O. Box 110, Cresbard, SD 57435. 

Questions?  Suggestions?  Comments?  Email us at keenspot@keenspot.com 

Thanks for your order.  It's appreciated!