|
MAIL ORDER
FORM (jewelry and t-shirts)
Please make check
payable and mail to:
Friends of Melissa
Chapman
PO
Box
3614
Union, NJ 07083
Name:
___________________________________________________________________
Address:
__________________________________________________________________
_________________________________________________________________
City:
________________________ State: _______ Zip
__________
Contact Phone or Email
(in case of questions about your order)
______________________
Method of payment:
____ Check or Money
Order
____ Visa
____ Mastercard
____ Discover
Daytime Phone number
(for credit card information)
_______________________________
We will call for credit
card information – Do not include credit card number on this
form
|
Item
Number |
Description |
Size
(if
t-shirt)
L or
XL |
QTY |
Amount |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PlPlease list
substitute items here:
|
Subtotal
Amount |
|
|
Shipping $4.00
(free – if
t-shirt) |
$4.00 |
|
Total
|
|
THANK YOU FOR
YOUR ORDER!
| 
