| PRINT THIS ORDER
    FORM AND MAIL WITH PAYMENT 
PO Box 224 
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| Circle Payment Method: Check Money Order | |
| Name:(print & signature) | |
| Address: | |
| City: | |
| State & Zip: | |
| Telephone: | |
| Item Name and Description | Price Each | Quantity | Total | 
| Please indicate color choice where appropriate. | 
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| Shell Animals(Please indicate which 3 you choose.) | $10.00 | ||
| Sand and Shell Frames 8" x 10" | $10.00 | ||
| Sand and Shell Frames 5" x 7" | $8.00 | ||
| Sand and Shell Frames 3" x 5" | $5.00 | ||
| Sand and Shell Clock | $16.00 | ||
| Sand and Shell Bathroom Set(Please indicate color choice) | $24.00 | ||
| Sand and Shell Tissue Boxes(Please indicate color choice) | $10.00 | ||
| Sand and Shell Bathroom Mirror(Please indicate color choice) | $16.00 | ||
| Shell Mirror 10" x 13" | $24.00 | ||
| Decorated Cane(Please indicate fill choice) | $25.00 | ||
| Undecorated Cane | $15.00 | ||
| Subtotal: | |||
| Shipping and Handling: | 
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| Minnesota Residents Please Add 6.5% Sales Tax: | |||
| Please allow 1 - 2 weeks for delivery. | Total : | ||