Samplers Country Collectibles- Faxable Order Form

Print this form, fill out, then fax to

It is also required all NEW wholesale vendors must fax or email a copy of their resale certificate prior to placing opening order. Email:

Company Name: (optional) Billing Address(as it appears on c.c.)
Contact Name: Name:
Shipping Address:
(Please circle one)
Residential or Commercial
State & Zip: State & Zip:
Phone/fax: Circle Payment: C.O.D, Visa , MC, AMX,or Disc.
Email: Credit Card #:
Resale# (if wholesale): Expiration Date:
Please Indicate your type of business (if wholesale):
(Please circle ALL that apply)

Brick & Mortar Storefront ~ Home Based Business ~ E Commerce Web Site

Other? :

Item Name and Description





Shipping and Handling:

Total :

Thank you for shopping at Samplers Country Collectibles.

If you are a new wholesale vendor, Please be sure to Fax or Email a copy of your resale certificate prior to placing this order.

Wholesale orders received without a resale certificate will not be processed.