ORDER FORM

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

Items ordered                                                      Quantity                       Price    

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___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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Virginia Sales Tax 5% (residents of Virginia only):                          ____________________

Shipping $5.00 within contiguous United States. $20.00 international
or Free shipping for any order over $100.                                      ____________________
                                                                                                 __________________
                                                                                                   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