L & R Order Form

L&R Logo
L & R Lock Company
2328 CAINS MILL ROAD
SUMTER, SOUTH CAROLINA 29154
PHONE: 803-481-5790
FAX: 803-481-5795
Authentic Recreations of Old World Design, Craftsmanship and Quality

Customer Name

Date:

Address:

Ship via:

Phone Number:

[ ] Prepaid----[ ] Collect

VISA/MasterCard #:

Expiration Date:

If a single page is not enough for your order, print additional copies and add your credit card info to the last page.

For Office Use Only

Ship Date:

Customer Name	Date:
Address:
	Ship via:
Phone Number:	[ ] Prepaid----[ ] Collect










VISA/MasterCard #:
Expiration Date:
If a single page is not enough for your order, print additional copies and add your credit card info to the last page.

For Office Use Only
Ship Date: