PRINT THIS FORM!**Old Woman In Purple Order Form**

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT (please make check or money order payable to Sherri Pierce) Old Woman In Purple PO Box 224 Stillwater, MN 55082 E-Mail: rubyk@winternet.com
Circle Payment Method: Check Money Order
Name:(print & signature)
Address:
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Item Name and Description	Price Each	Quantity	Total
Item A Original Purple Hair: Gray White Red Blonde Brown Black	$48.00
Item B Leopard Hair: Gray White Red Blonde Brown Black	$48.00
Subtotal:
Washington Residents Please Add 8.6% Sales Tax:
Please allow 3 - 4 weeks for delivery of out of stock items. In stock items shipped immediately.		Total :