P.O. Box 4 • Eaton Rapids, MI 48827
(517) 663-9100 • FAX (517) 663-8647
email (info@upcharts.com)
Order Form

Date________________ Telephone__________________ Fax _________________

Name_______________________________________________________________
Shipping Address______________________________________________________
City____________________________________State_________Zip_____________

E-mail address______________________________
Standard Size: 30"x24" Frame Finish: Natural Cedar

Lake Name___________________________________________
County (important!!!), ______________________ State_________

Custom Items (Call for Pricing)____________________________

 Amount:

$695.00


$_____________
Subtotal:
Sales Tax for Michigan residents (6%):
Packing, shipping & insurance ($59 fee for standard size):
Allow 4-8 wks. for delivery. Priority Orders are available for an additional charge:
Total:		 $_____________
$_____________
$_____________
$_____________
$_____________
Check payable to: UP Charts, P.O. Box 4 • Eaton Rapids, MI 48827
Charge and Mail or FAX to: FAX (517) 663-8647
Amex Visa MC Discover
Card #_________________________________ Exp. date_______Security Code_______
Name of Cardholder_______________________ Signature_________________________
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