Print-able Order form

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO: Chancery Lane Primitives 3 Chancery Lane Rochester, New York United States 14625 Phone #: 585-787-0361 Fax #: Email: sfogle@rochester.rr.com
Circle Payment Method: Check Money Order
Print Name:
Address:	Email:
City:
State & Zip:
Telephone:	Signature:_____________________

Item Name and Description	Quantity	Price














Subtotal:
Shipping and Handling:
New York residents must add 8.00% sales tax-
MAKE CHECKS PAYABLE TO: Sandie Fogle	Total :

Thank you for shopping at Chancery Lane Primitives.