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Western Star Lodge #21 |
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CAREFREE CREATIONS |
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ORDER FORM |
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Bill to: |
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Ship to if different than bill to: |
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Name |
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Name |
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Address |
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Address |
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Phone |
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Phone |
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JACKET |
BLACK |
TAN |
NAVY |
ROYAL |
QTY |
PRICE |
TOTAL |
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SMALL |
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41.00 |
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MEDIUM |
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41.00 |
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LARGE |
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41.00 |
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X LARGE |
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41.00 |
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2X |
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44.00 |
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PERSONALIZATION |
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2.00 |
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POLO |
NAVY |
GRAY |
RED |
WHITE |
QTY |
PRICE |
TOTAL |
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SMALL |
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26.00 |
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MEDIUM |
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26.00 |
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LARGE |
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26.00 |
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X LARGE |
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26.00 |
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2X |
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28.00 |
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PERSONALIZATION |
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2.00 |
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HAT - ROYAL |
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QTY |
PRICE |
TOTAL |
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ONE SIZE |
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10.00 |
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* All prices include tax |
SUBTOTAL* |
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*See shipping charges below. |
SHIPPING* |
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TOTAL |
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Alternate lodge name and number:
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Alternate city and state: |
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Special instructions: |
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**A portion of the proceeds will benefit Western Star Lodge** |
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Order can be picked up at Western Star Lodge, Carefree Creations or shipped
to your home. |
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I will pick up my order at Western Star |
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I will pick up my order at Carefree Creations |
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Please ship |
Up to 30.00 |
$4.00 |
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30.01 - 60.00 |
$6.00 |
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60.01 - 85.00 |
$8.00 |
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85.01 - 125.00 |
$10.00 |
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125.01 + |
$12.00 |
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Cash - on pick-up orders only. |
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Check ** payable to "Carefree Creations" |
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Credit Card |
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Acct. No. |
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Exp. Date |
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Signature |
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SEND ORDER AND PAYMENT TO: |
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CAREFREE CREATIONS |
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15090 Mock Road, P.O. Box 81, Berlin Center, Ohio 44401 |
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PHONE (330)-547-3412; FAX (330)-547-7534 |
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