For Fax Orders:              
Print out this order
form and fax it to my 
TOLL-FREE MOOSE FAX LINE
1-888-371-3434

For Mail Orders:              
Print out the order form 
below and mail it to 

Moose's Mail Order Dept.
Widerview inc.
P.O. Box 136	
Petaluma, CA 94953

make checks payable to:
Widerview inc.
		

Bill to Address:__________________________________________________
                    _______________________________________________________________________
                    _______________________________________________________________________

Ship to Address:__________________________________________________ 
  (If different)    _______________________________________________________________________  
                    _______________________________________________________________________


Contact Phone # ________________________Email:_____________________________________________



I would like to order these "Moosified" items listed below!

Item #		      Description		     Price	      Quantity	       Total

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

                                                            Subtotal of order:_______________

  (We will phone you with estimated shipping charges, prior to delivery)Shipping:____________ 
    
               (include 7.50% sales tax if items being shipped to California) Tax:___________

                                                      Total for "Moosified" Order:___________ 

Payment Information

Method of payment (please check one)

Credit card:____Check or money order enclosed:_____(payable to Widerview Inc.)

Information below required to process Credit Card orders:

Type of Credit Card:	Visa___Mastercard___Discover/Novus___American Express___ 

Credit Card Card Number: __________________________________

Valid from: ____Expiration date:_______

Name as it appears on credit card: ______________________________________________

Card holders phone: (please be sure to include area code) _______________________

Card Holders signature: (Required)_______________________________________________   

             
                    "Thanks a heap for your order Mooseketeers!" ~ Moose


          Lost Moose Mercantile Company is an online catalog store owned & operated by

                                        Widerview Inc.

                                   Corporate Business Office
                                P.O. Box 136, Petaluma, CA 94953	
			             Email: corp@widerview.com