PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO: Country Gift Connection 1010 Knight Street Bertrand, NE United States  68927 Phone #: 308-472-3261 Fax #: Email: countrygift@charter.net Circle Payment Method:          Check    Money Order               Print Name:   Address:   Email:   City:       State & Zip:       Telephone:   Signature:_____________________ Item Name and Description Quantity Price                                                                                     Subtotal:       Shipping and Handling:       NE residents must add 5.5% sales tax-        MAKE CHECKS PAYABLE TO: Country Gift Connection   Total :   Thank you for shopping at Country Gift Connection.