NAME _________________________________________________

 

ADDRESS ______________________________________________

 

CITY ___________________________     STATE _____________

                                                                     ZIP _____________

PHONE #:__________________ e-mail _______________________

Text Box:   PLEASE PRINT OUT THIS FORM FOR 
CHECK & MONEY ORDER PAYMENTS

MAKE CHECKS OR MONEY ORDERS PAYABLE and SEND TO:

“Very Special Things”

259 Sharadin Road    Kutztown, PA 19530-9209

000610-683-5398000

            ORDERS WILL BE SHIPPED WHEN CHECK CLEARS IN OUR BANK

Description

Item #

Price

Quantity

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please print personalization for

matted design print in space below

                       TOTAL COST OF  ITEMS

                                          ( SUB TOTAL )

 

 

 USPS basic shipping/packing, add 16% 

                                  minimum $1.00

 

 

 

 

 

 

                                           SUB TOTAL #2

 

 

          PA  residents please add 6% sales tax

                                              to sub total #2

 

—————————————

                                              TOTAL