MAIL ORDERS

To submit your order, please fill out the form first and then print it.

Send your check, money order, or casher's check with your order form to:

Red River Drugs and Gifts;  1603 Ringgold;  Coushatta, LA 71019



  Item Name / Description Quantity Price
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
  Subtotal:
  Insurance, if desired:
  Louisiana residents add 9% sales tax:
 
  TOTAL:




Customer Information:

  Name: 
  Street Adress: 
   
  City, State/Province: 
  Zip/Postal Code: 
  Country: 
  E-mail: 
  Phone: 


  I will be enclosing:  Money Order
Check
Cashier's Check


Before proceeding, make sure you have provided
all the necessary information about your order.





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