If you would rather fill out this form than use the on-line process, please send it to the address below:

                                                           Date  ___/___/___

 ORDER FORM

Item #

Item Description

Color

Quantity

Cost Each

Total Cost

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  (please circle which card type)

 

Shipping Cost

 

   

 

ORDER TOTAL

 

  Payment Method:  ___  Credit Card    ___  Check ___  Cash                

 (please print legibly)

   Credit Card Number:   _______ - _______ - _______ - _______ Expire Date: MO____ YR____

 Card holder name:      _________________________________________

  Email address: _______________________________________________

 CARD BILLING ADDRESS:

 Street Address :           _________________________________________ Apt. # _______

 City:     _______________________________  State: _______  Zip: _____________

   Find us on–line at:    www.thepathway.com      or Email us at:   PAD@thepathway.com

Please mail to:

 The Pathway TSF

 75 Pine Hill Avenue                    

 Nashua, NH 03064

    Or:

  FAX 708-570-4164

 

 We use this information only for this order, and it is not nor ever will be shared with anyone nor sold to anyone.

  Checks may take a few days to process after receipt. We will notify you by email when the order ships, which is usually the   following business day.