BLACK SWAN CREATIONS

P.O. Box 237
Sutherlin, OR
97479

PRINTABLE MAIL IN ORDER FORM


Address:
Name:_________________________________
Address:_______________________________
______________________________________
Phone:________________________________
E-mail:_______________________________

Shipping address:(only if different from above)

Name:_________________________________
Address:_______________________________
______________________________________
Country:______________________________
Phone:________________________________
E-mail:_______________________________

Is this a gift? YES_____ No______

Item: "Ashley of the House of Friesian" Hard Bound, Book

Amount:_______Price $14.95 Each. Extended Price ______________

Domestic Mail:
$4.05 for the first book $2.00 for each additional book__________

International Mail:
please add $9.00 for the first book $2.00 for each additional book___________

Total Amount Enclosed $______________________USD (US Dollars)

Additional Notes:______________________________________
____________________________________________


Please pay by Check or Money Order US DOLLARS
Allow 2-4 weeks for delivery.