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Order Form


For mail in orders please print this form and mail with payment to the address bellow.

Customer:                                                                   Ship to: (If different from customer address)


Name:___________________________ 

Name:___________________________


Address:_________________________ 

Address:_________________________


________________________________ 

________________________________


City:____________________________ 

 ________________________________


State:_______________Zip_________ 

State:_______________Zip_________


Telephone:_______________________ 

Telephone:_______________________


E-mail(optional)____________________________

Mail Order Form with check or money order made payable to:

                                                                                          Phyllis B. Stafford

90 Brandywine Lane

Suffield, Ct 06078

Please remit funds in US dollars

Allow 1-2 weeks for delivery

If you have any questions please contact us

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