Order Form
(print this form, fill it out, and mail to the address below)

Bill Newby - PO Box 642 - THOMPSON FALLS, MT 59873
Phone : (406) 827 - 7291

Character Choices: Alligator, Smiley Face, Tractor, Truck, Moon, Train, Teddy Bear, Angel, Flower w/ Heart, Daisy Flower, Butterfly, Dolphin, Star, Heart, Football, Soccer Ball, Baseball, Basketball

ORDER DATE:

NEEDED BY: (We'll do our best!)

Name	Color Choice (primary, black and white, or pastel)	Character #1	Character #2

PLEASE PRINT CLEARLY!

TOTAL # OF PIECES (LETTERS AND CHARACTERS) x $1.75 =

Florida Residents add 6% Sales Tax =

Shipping Charge for 1 to 3 Names - $4.00
Shipping Charge for 4 or more names - FREE
Shipped by Postal Service - Continental U.S. Only!
One Shipping Address Per Order Please!!

TOTAL =

PAYMENT
We accept Checks and Money Orders made payable to Shirley Newby

Sold To:

Name:
Address:
City:
State/Zip:
Phone:
Email:

Ship To:

Name:
Address:
City:
State/Zip:
Phone:
Email:

Allow up to 3 weeks for delivery. THANK YOU FOR YOUR ORDER!