Creations by Carol!  
59 Emmons Road  
Lansing, New York 14882
phone : (607) 533 - 7160

Customer Information

Name:     _____________________________________

Address:  _____________________________________

          _____________________________________

Telephone Number :	(_____) ______-_______      


Shipping charges will be $9.00 for the first item
shipped East of the Mississippi and $15.00 for the 
first item shipped Wast of the Mississippi. 
Call for shipping price for mulitple.  
All orders will be delivered by UPS.  

ITEM____|___DESCRIPTION (specify color choice)__|QTY|__PRICE_|  

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|

|_______|_______________________________________|___|$_________|
                                         Subtotal    $__________
                                         Shipping  + $__________
                    NY Residents Add 8% Sales Tax  + $__________
							
                                            Total  = $__________

Please Indicate Your Payment Method 
[  ] 	Check or Money Order (please mail with order)
[  ]	Credit Card (VISA or MasterCard Only!)
	Card No.  _ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _ 	Exp. Date _ _ /_ _

Customers who do not wish to send their credit information 
through the mail may contact us at (607) 533-7160. 
						
Thank You!