1. PRINT THIS FORM OUT
2. FILL OUT FORM
3. MAIL CHECK OR MONEY ORDER TO THE ADDRESS BELOW
*VISA, MASTERCARD AND ALL USA CHECK AND MONEY ORDERS ACCEPTED
(FOR INTERNATIONAL ORDERS CONTACT US FOR SHIPPING AND HANDLING)

Make checks payable to Jane Howe

Jane Howe
P.O. Box 56
Lake Ann, MI 49650
Phone:(231)275-5900

Product Name:	Unit Price:	Quantity:	Total Price:
Subtotal:
Shipping and Handling Charge: 1 - 5 Items add $5.00 Additional Night Lights add 50¢ per additional Night Light
Add 6% Sales Tax for Michigan Residents Only
Total:

PAYMENT INFORMATION:

Method of Payment	Circle one: Visa / Mastercard / Check / Money Order
Credit Card #		Exp Date

SHIPPING ADDRESS:

Full Name:
Street Address:
City:
State:
Zip Code:

SHIPPING ADDRESS: (If sending as a gift)

Full Name:
Street Address:
City:
State:
Zip Code:

CONTACT INFORMATION:

Email Address:
Daytime Phone:
Evening Phone: