Jake's Marketplace, Inc. 830 W. Route 22 #290 Lake Zurich, Illinois 60047 Phone - 1-847-277-9814 / Fax 1-847-277-9815			Order Form
To my friends at Jake's, Please send me the items listed below. It is understood that they must meet with my complete satisfaction upon actual examination, or I may return them within fourteen days for a prompt exchange or 100% refund.
Name			Date
Number & Street			Home Phone #
City & State			Zip Code
Using a charge card? Print your name above exactly as it appears on your card, include your signature. - - VISA - Master Card - Discover - American Express Card No. Exp. Date Signature Billing address of card. Bus. Phone #
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Use Our Toll Free Number To Place Your Order. x 1-888-ITS-JAKE x Please give second choices wherever possible. Thank You, Jake			Sub Total		$
			Sales Tax		$
			Postage		$
			Grand Total		$