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| Name:_____________________________________________________________ |
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| Street Address:___________________________________________ |
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| _______________________________________________________ |
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| City:______________________ State:_______ Zip:_____________ |
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| Day Phone:____________________ Eve Phone:________________ |
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| (Optional) E-mail:________________________________________ |
I would like to order the following
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Indiana Residents Add 5% Sales Tax |
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Please Add $4.50 Shipping and Handling on all Orders inside the US |
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Total |
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Make check or money order payable to: |
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Rosaries For Our Lady
Mail check or money order and this form to: |
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Rosaries For Our Lady
4699 E. 266th St. Arcadia, Indiana 46030 |
| Please contact me either by phone or e-mail
for shipping and handling rates outside US. To Inquire about questions regarding your order please call: (317) 984-5577 Thank You for Your Order |