ORDER FORM

Name: _______________________________            Date: ______________
Street ________________________________   
City/State/Zip: _____________________________
Telephone number: (____)____-________
E-Mail: ___________________________________   

Items ordered                                                           Quantity     Price    

_______________________________________________________ ___________  ________
_______________________________________________________ ___________  ________
_______________________________________________________ ___________  ________
_______________________________________________________ ___________  ________
_______________________________________________________ ___________  ________
_______________________________________________________ ___________  ________

Virginia Sales Tax 5% (residents of Virginia only):                          _________

Shipping $5.00 within contiguous United States  
Free shipping for orders over $100.                                             _________

Actual cost for international shipping                                           
                                                              MERCHANDISE TOTAL    _________
                                                                                                  
Your order form may be copied and mailed or for expedited orders, please contact me by e-mail Jordancd@verizon.net        

Please make checks payable to: Catherine Jordan.
Mail to: 3435 Pleasants Road, Powhatan, VA 23139