5424 Springlake Way
Baltimore, MD 21212
Tel (410) 323-7975

Please print out this order form and mail with payment to the address above.

Customer: Ship to: (if different from customer address)
Name:____________________________ Name:____________________________
Address:__________________________ Address:__________________________
_________________________________ _________________________________
City: _____________________________ City: _____________________________
State: ______________ Zip: __________ State: ______________ Zip: __________
Telephone: ________________________ Telephone: ________________________

 
Qty. Catalog No. Size
18 or 24 count		 Description Unit Price Total
           
           
           
           
           
Please make checks or money orders payable to: Janet Patacca

Please remit all funds in US dollars and allow 2-3 weeks for delivery.

Shipping within the US is $5.00.  Please call for overseas charges.

 Subtotal  
Sales Tax
(Maryland deliveries add 6%)		  
Shipping Charges

$5.00
Total Enclosed  

 

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