Mailing List
E-mail Address
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.
1
2
3
4
5
6
7
8
9
10
2.
1
2
3
4
5
6
7
8
9
10
3.
1
2
3
4
5
6
7
8
9
10
4.
1
2
3
4
5
6
7
8
9
10
5.
1
2
3
4
5
6
7
8
9
10
6.
1
2
3
4
5
6
7
8
9
10
7.
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9
10
8.
1
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5
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7
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10
9.
1
2
3
4
5
6
7
8
9
10
10.
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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