orderform

PRINT THIS ORDER FORM

AND MAIL WITH

PAYMENT INFORMATION TO:

Deb Malewski

Country Colours

1308 Hall St. Eaton Rapids, MI 48827 USA

Circle Payment Method: Check Money Order VISA MasterCard Discover

Print Name:_______________________________________________

Address: ________________________________________________

City: ___________________________________________________

State & Zip:______________________________________________

Email: __________________________________________________

Credit Card Number:________________________________________

Expiration Date:__________________

_________________________

Signature:_______________________________________________

Item Name and Description Quantity Price

--------------------------------------------------------------------------------------------------

Subtotal _____________

Shipping _____________

Mich. Residents add 6% sales tax _____________

TOTAL DUE _______________