| ORDERED BY: |
| Name: ______________________________________________________________________ |
| Street: ______________________________________________________________________ |
| City: __________________________________ State: ___________ Zip: ___________ |
| Phone No: _____________________ Email Address: __________________________________ |
| Size desired: _________ 60" @ $30 __________ 80" @ $35 _________ 100" @ $40 |
| Color desired: _________________________________________________________________ |
| Special Order: If you desire a shawl wider than 28" there is an additional cost of $8 for each width increase. Please mark the width you desire: |
| 32 inches with an additional cost of $8 ________ | |
| 36 inches with an additional cost of $16 ________ | |
| 40 inches with an additional cost of $24 ________ | |
| 44 inches with an additional cost of $36 ________ |
| Merchandise Total: | ___________ |
| Additional Width Total: | ___________ |
| Shipping & Handling (UPS): | $10.00 |
| Total Amount Enclosed: | ___________ |