 |
|||
 |
|||
 |
|||
 |
|||
 |
|||
 |
|||
 |
|||
 |
|||
|
 |
|||
| Would you like to purchase a St. Elmo’s Signature Item? Fill out this form, print it and then mail or fax us your order or inquiry. Send your check or money order with the form to the address listed at the bottom. |
|||
 |
|||
 |
Date: | ||
| Email: | |||
| Name: | |||
| Street Address: | |||
| City: | |||
| State: | Zip: |
|
|
Shipping Address (If different than billing) |
|||
| Name: | |||
| Street Address: | |||
| City: | |||
| State: | Zip: |
|
|
| Ceramic mugs | Price | Quantity | Total | |
|
The Angel 12 oz | $7.99 | ||
| The Angel 16 oz. | $9.99 | |||
| The Pooch 12 oz | $7.99 | |||
| The Pooch 16 oz | $9.95 | |||
| The Kitty 12 oz | $7.99 | |||
| The Kitty 16 oz | $9.95 | |||
| The Serpent 12oz | $7.99 | |||
| The Serpent 16 oz | $9.95 | |||
| Travel Mugs | ||||
| Cranberry Red | $9.99 | |||
| Icy Blue | $9.99 | |||
| Coffee (12oz, whole bean) | ||||
| St. Elmo’s House Blend | $9.99 | |||
| St. Elmo’s Decaf | $10.99 | |||
| St. Elmo’s Espresso Blend | $9.99 | |||
| St. Elmo’s Decaf Espresso | $10.99 | |||
| Shirts and Tees | ||||
| Please inquire about the availability of shirts and tees | ||||
|
Total
order |
||
| Credit Card Information | |||
| Please indicate your payment choice:
VISA
MC
AmEx
Discover |
|||
| Name on Card | |||
| Card Number | |||
| Expiration Date | |||
Send your money order or cashiers
check along with a printed copy of this form to: Questions about ordering can be asked at NoraStElmos@hotmail.com |
|||