Bag Order Form Bag Order Form

Date:.........................

Name:...................................................
Address:...........................City:....................State:.....Zip:........
Telephone number:........................
e-mail address:............................

Quantity:.......Style #:............Price:$..........

Quantity:.......Style #:............Price:$..........

Quantity:.......Style #:............Price:$..........

Quantity:.......Style #:............Price:$..........

Quantity:.......Style #:............Price:$..........

Total $..........................
+Shipping $3..............................
orders over 3 Qty. $1. each...........................
Total $......................................

Make check payable to: Elaine DeRosa Mail to: Elaine's Originals
29 Rancho Road
Tustin, CA. 92780
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