The Cavalier Image Order Page

Customer Order

First Name:

Middle Initial:

Last Name:

Day Time Phone #:

E-Mail Address:

Billing Address

Address Line 1:

Address Line 2:

City:

State:

Zip:

Shipping Address ( If Billing And Shipping Address Are The Same )

Address Line 1:

Address Line 2:

City:

State:

Zip:

Order Items

Item	Size	Quantity	Price Per	Item Total
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		0	$	$
		0	$	$
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Flat Rate Shipping & Handling ( 3 Day USPS $6.50): $
Order Total: $
Order Comments
Enter Comments Below: We will try to honor any special requests and will confirm via e-mail.

Jane Helminski P.O. Box 1033 Woodruff Wisconsin 54568

THE CAVALIER IMAGE
Jane Helminski

Order Page
715-358-1983