Jack's Tobacco & MCS Order Form

Jack's Tobacco & MCS
13640 W. Capitol Dr.
Brookfield, WI 53005

PHONE: 262-783-7473
FAX: 262-783-6480

 CLICK HERE to go to

Jack's Tobacco & MCS Printable Order Form Page.

Please enter the item information for each pipe and/or tobacco you want to order and calculate your total charges including shipping. When complete, click the "Submit Order" button and your order will be e-mailed directly to us.

Your browser will probably issue a warning that you are sending unsecured data via e-mail. This is a default message generated by most browsers when sending form data with an e-mail client. We do not accept online payments!

Qty. Item # Description Unit Cost Item Total
  1. $ $
  2. $ $
  3. $ $
  4. $ $
  5. $ $
  6. $ $
  7. $ $
  8. $ $
  9. $ $
10. $ $

SHIPPING CHARGES:
U.S. Orders: $10.00
Note: Add $10.00 per first pound. Others will be calculated at time of shipment.

Make checks payable to Jack's Tobacco & MCS.

NOTE: Wisconsin shipping addresses must add 5.1% sales tax.

       
SUBTOTAL:  $
SHIPPING:  $
GRAND TOTAL:  $

Method of Payment  
Call us at 262-783-7473 for Credit Card payments!

Billing Address
Name: 
Address 1: 
Address 2: 
City: 
State: 
Zip+4: 
Country: 
Daytime Phone: 
Evening Phone: 
Fax Number: 
E-mail Address:  REQUIRED


Shipping Address (if different)
Name: 
Address 1: 
Address 2: 
City: 
State: 
Zip+4: 
Country: 
Daytime Phone: 
Evening Phone: 
Fax Number: 
E-mail Address:  REQUIRED


Comments, Questions or Special Needs:

Your responses are e-mailed directly to us.

Thank You! We appreciate your business.

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