Boutique OrderForm

Guiding Eyes for the Blind Boutique

Guiding Eyes for the Blind
Boutique Order Form

Please complete the following form carefully. Items are not exchangeable or refundable.
Make checks payable to GEB and mail with this completed form to the following address:

Mary Ellen Pratt 1110 Wisconsin Road
Derby NY 14047
Phone: (716) 947-5135
E-mail:  pratts4geb@aol.com

Please Print

Date __________

Name_____________________________ E-mail Address____________________________ Phone_______________
 
Ship to:   Street_______________________________ City__________________ Apt #______ State______ Zip_______

Orders will be shipped within 8-10 weeks from receipt of your completed order form and check unless the item is back ordered. Customers will be notified of the status of back orders. If special orders have been placed, allow additional time for delivery. Checks will be deposited when orders are shipped.

Embroidery
Code  
 Item Description 
 Color 
 Size 
 Qty 
Unit Cost 
Additional Cost for ExtendedSizes **
 Total 
               
               
               
               
               
               
               
               
Subtotal  
Shipping Charges *  
Total  

* Shipping Charges
$20 – $29 = $6 $60 – $69 = $10
$30 – $39 = $7 $70 – $79 = $11
$40 – $49 = $8 $80 – $89 = $12
$50 – $59 = $9 $90 – $99 = $13
   Over $100 – Please call for charges   
** Additional Cost for Extended Sizes
Color choices are limited – please call
2XL
$3
3XL
$4
4XL
$5
5XL
$6
6XL
$7