| SHIP TO: |
ORDER FORM
| Quantity | Item | Design | Price | Total |
|---|---|---|---|---|
| Teapot | tame rose/wild rose/pansy/lilac | $39.95 | ||
| Cup/Saucer 4oz. | tame rose/wild rose/pansy/lilac | $19.95 | ||
| Cup/Saucer 8oz. | tame rose/wild rose/pansy/lilac | $29.95 | ||
| Baby Bootie | pink rose/blue rose (include info) | $14.95 | ||
| Baptismal Cross | pink rose/blue rose (include info) | $19.95 | ||
| Bisque Egg | tame rose/wild rose/pansy/lilac | $29.95 | ||
| Ball Ornament | wild rose/winter scene | $14.95 | ||
| Snowflake Ornament | wild rose/winter scene | $14.95 | ||
| Ornament Stand | For display | $3.00 | ||
| Sugar Shaker | wild rose/pansy/lilac | $22.50 | ||
| Pitcher | wild rose/pansy/lilac | $22.50 | ||
| Tray | wild rose/pansy/lilac | $39.95 | ||
| 3 pc. Set | wild rose/pansy/lilac (save $5) | $79.85 | ||
| Plate | wild rose/pansy/lilac | $44.95 | ||
| Wild Rose Cards | 8 pack | $6.95 | ||
| Letter Opener | wild rose/pansy/lilac | $14.95 | ||
| Brooch | wild rose/pansy/lilac | $24.95 | ||
| Limited Edition ND 2008 Ornament | North Dakota Winter Farm Scene | $12.50 | ||
| M.Lark/Wild Rose Ornamentt | North Dakota and/or 2008 | $12.50 | ||
| ND Country Church Ornament | North Dakota and/or 2008 | $12.50 | ||
| Framed 8x10 Print | Wild Rose | $14.95 | ||
|
Shipping & Handling:
Up to $24.99 20% $25.00 - $49.99 15% $50.00 & up 10% |
|
MAIL OR FAX TO:
Vida Klocke 706 Grant Place Underwood, ND 58576
701-442-3478 (phone/fax)
e-mail klocke@westriv.com
| All you need to do is print out the form above and fill it in, or fill it in on screen and print it out. Enclose a personal check, money order, or enter your credit card information in the indicated areas. Please do not forget to sign the form for credit card approval. |