** Order Form: Online
	
Tom Burgoon Store **   
    Please print this form, complete your request and send to:
     TOM BURGOON MAGIC PRODUCTIONS LTD.
                P.O. Box 17740
                Kansas City, Missouri 64134 USA
     Phone: 
                816-560-4260 | Email: tom@tomburgoon.com
    Make check payable to: Tom Burgoon
    
       
     
        
      | Name: | 
        | 
     
     
      | Phone: | 
        | 
     
     
      | Street: | 
        | 
     
     
      | City: | 
        | 
     
     
      | State and Zip Code | 
        | 
     
     
      | E-Mail | 
        | 
     
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
      
    
    
       
     
        
      | Item Name | 
      Quantity | 
      Price Each | 
      TOTAL | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      | Alternate choice if one is not available: | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
        | 
        | 
     
     
      |   | 
        | 
      Merchandise Total: | 
        | 
     
     
      |   | 
        | 
      Sales Tax x.xx%  
       (MO only) | 
        | 
     
     
      |   | 
        | 
      Shipping & Handling | 
      
        0.00 (included) 
       | 
     
     
      |   | 
        | 
      TOTAL AMOUNT ENCLOSED: | 
        | 
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
      
    
    
       
     
        
      | Payment Method: | 
      _____ Personal Check _____ Money Order | 
     
     
       
       Signature: 
        | 
       
       _______________________________________________________________ | 
     
     
     
     
     
     
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
      
    
    Return to site