KensTwistedMind.com Order Form

Order by Mail
KTM Enterprises, LLC
P.O. Box 576
Belle Chasse, LA 70037

Order by Phone
1(800)827-4303
9am-5pm Central
Monday-Friday

Order by Fax
1(800)825-1902
24 hours a day

Ship To:
 
Name:
Address:
City:
State: ___
Phone:

 
 
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_____________________
_____________________
Zip: ____________
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Bill To:
 
Name:
Address:
City:
State: ___
Phone:

 
 
_____________________
_____________________
_____________________
Zip: ____________
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Product# Product Name Price Quantity Total
         
         
         
         
         
         
         
         
         
         
         
         
         

If remittance is by check or money order
made payable to KTM Enterprises, LLC.
Sorry no COD.

Sub Total:  
Tax:  
Shipping:  
Grand Total:  

Charge Credit Card:   ___Visa     ___American Express     ___MasterCard

Card Number: ________________________________     Exp. Date: ___________ (MTH/YR)

Are you 18 or older?     ____Yes     ____No

Authorized Signature: ______________________________________________