Jewelry Order Form - CLAN LITTLE SOCIETY NORTH AMERICA

JEWELRY ORDER FORM

Add Shipping & Handling charges:

1 - 4 Items $2.00	________
5 + Items $0.50 for each additional item	________
TOTAL AMOUNT ENCLOSED	________

Print This Page and Send Completed Order Form
AND
Your Payment To:

Leroy & Teresa Little
19 Central Avenue
Bath, ME 04530
(207) 443-3136
leelittle70@yahoo.com

Make Check or Money Order Payable To Clan Little Society NA

Address where you want the items shipped:

Name ______________________________

Address _____________________________

City _____________________________

State & Zip _______, __________ __________

Telephone # (_____)_________-_____________

Please Send US Funds Only!