Proficient Billiards Mail in Order Form (print this out and send with your payment)

Name___________________________________________________________________

Address_________________________________________________________________

City________________________________________State__________Zip___________

Description of Goods:

Select type of shipping:

• UPS insured Ground Shipping (default)
• UPS 3 day
• UPS 2 day select
• UPS Overnight

Price of Goods $_________________

Shipping Costs $_________________ (free if applicable)

6% Tax in PA   $_________________ (if applies)

Total Amount  $_________________

Payments can be sent and made out to:

Proficient Billiards

202 South State Street

Ephrata PA, 17522

Personal Checks, Money Orders, and Certifieds held 10 business days
Credit Cards & USPS Postal Money Orders ship as soon as they are received

VISA or MC #’s _________ / _________/ ________ / _________ exp _____/ _____

Cardholders Name (if different from shipping)____________________________________

Address_________________________________________________________________

City________________________________________State__________Zip___________