Order Form

SOLD TO:
Name:
Address:
City:
State: Zip:
Phone No.
E-mail

 

SEND TO:
If you desire our order shipped to another person, or to another address, please indicate here

Name:
Address:
City:
State: Zip:
Phone No.

 

Backgrounds: Antique Blue Wash
Bird Colors: Yellow/Red Yellow/Rose 2-Tone Blue
Pie Plates and Egg Seperators:
Red Barn Antique Blue Wash Yellow Spice Country Blue

 

Description:
Design #: Border #: Inscription #:

Personalized information for front of plate:

 

 

 

 

Personalized information for back of plate:

 

 

 

 

 

Cost: $
6% Sales Tax (PA residents only):  
Postage, Insurance: $20.00 each  
TOTAL:  

Please check one:

MasterCard Visa Am. Exp. Check Traveler's Check Discover

Credit Card No.:
Exp. Date:

 
Customer Signature Required: