 |
Boutique Order BichonHealth.org Kathleen Loynachan 56446 - 295th Avenue Chariton, IA 50049 |
| Customer's information |
| Name: | |
| Address: | |
| City: | |
| State: | |
| Zip: | |
| Phone: | |
| Email: |
| Items Ordered |
| # | Description | Quantity | Price | Amount |
| C | DNA Litter Kit | $5.00 | $ | |
| D | DNA Individual Dog Kit | $2.00 | $ | |
| H | Crystal and Silver necklace | $125.00 | $ | |
| I | Onyx natural stone and gold necklace | $135.00 | $ | |
| J | Christmas Ornaments | $25.00 | $ | |
| Total Amount Enclosed: | $ | |||
| Mail To |
To order please print out and fill in this form, and send it with your check (US funds only) or money order to:
Kathleen Loynachan
56446 - 295th Avenue
Chariton, IA 50049
(Sorry NO credit card orders)
All items include domestic shipping