Mail Order Form
|
Elizabeth Park A Century of Beauty Order Form c/o Alicia Cornelio 327 Whitewood Drive Rocky Hill, CT. 06067 |
| First name: |
| Last name: |
| Organization: |
| Telephone: |
| Address: |
| City: |
| State and Zipcode: |
| Email: |
| Today's Date: mmddyyyy |
| Number of Hardcover Copies: ____ @ $20.00 = $_________ subtotal |
| Number of Softcover Copies: ____ @ $12.00 = $_________ subtotal |
| Shipping = 1 book: $3.00, 2 books: $3.95, 3 books: $4.95 |
| Total payment = $_________ |