|
Name ______________________________ Address____________________________
City________________________________
State ________Zip ___________________
E-mail ______________________________
Telephone __________________________
|
Please print this form and fill in quantities and prices. Sub-total the form, add shipping, tax, and total. Make checks payable to Li Hertzi Design at the address below. All returned checks are subject to a $20.00 return fee. Please mail your check and this order form to the address below.
|
