Mail or Fax this Order Form to:

The Back Pack
PO Box 125
Ernul, NC 28527       252 244-0728 (phone/fax)

Name ___________________________________________________ Date ______________2016

Address ________________________________________________Phone __________________

City __________________________________________________ State________ Zip _________


Item #


Price Each



Credit Card Information    



Please circle one:

       Discover                 Master Card            Visa

Office use:

 Shipping Date _____BO shipping date________

 App # ________Check #________B #_______

Shipping & Handling Charges:

    15% of Sub-total
    $5.00 Minimum

 Due to increases in shipping costs, this charge   
 may be adjusted based on our actual shipping 
 cost including packaging/handling at time of 
 purchase. Please include you phone number 
 on  this form in case we need to contact you   
 regarding your shipping charge.

 We ship by USPS or UPS

Sub-total _____________

S&H  _____________

Sub-total _____________

NC Res. - 6.75 % Sales tax 


Total  _____________

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