PRINT THIS ORDER FORM AND MAIL WITH PAYMENT
(please make check or money order payable to Ron Kuschel)
Name Art

PO Box 224
Stillwater, MN 55082
E-Mail: rubyk@winternet.com

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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 name choice next to theme choice.

 

    

Sports Theme Picture     Name:

$9.99

    

Ballerina Theme Picture     Name:

$9.99

    

Cats Theme Picture     Name:

$9.99

    

Horses Theme Picture     Name:

$9.99

    

Dogs Theme Picture     Name:

$9.99

    

Racing Theme Picture     Name:

$9.99

    

Subtotal:

  

Shipping and Handling:

$2.99

Minnesota Residents Please Add 6.5% Sales Tax:

  

Please allow 1 - 2 weeks for delivery.

Total :