| |
| Picture
Name: ________________________ Quantity: ________ Price/ea.: _____________
Total: ______________ |
| Picture
Size: |
Standard |
Custom (where available): _________________________ |
|
| |
| Picture
Name: ________________________ Quantity: ________ Price/ea.: _____________
Total: ______________ |
| Picture
Size: |
Standard |
Custom (where available): _________________________ |
|
| |
| Picture
Name: ________________________ Quantity: ________ Price/ea.: _____________
Total: ______________ |
| Picture
Size: |
Standard |
Custom (where available): _________________________ |
|
| |
| *add $5 to all purchases for Shipping costs Total price for order:_______________ |
| |
| Ship to: |
| Name:___________________________________
Apt.#:__________________ P.O. Box#:__________________ |
|
| Street
address :____________________________ City:__________________ State:_______
Zip:____________ |
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| |
 |
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| Make checks
payable to: |
Dennis Deitz |
| |
| Send check and form to: |
Dennis Deitz
1804 Old Murphy Road
Franklin, North Carolina 28734 |
