Order form
Date:_____________________________
Name:______________________________________
Phone:____________________________
Address:____________________________________
Email:_____________________________
City:_______________________________________
Note: U.S.A. only  
Zip:_______________
State:__________________
Item #
Description
Color
Quantity
Price
Line Total
           
           
           
           
           
           
           
           
           
           
Sub Total
  
Tax Illinois residents
only 6.5 %     x .065
  
Shipping
6.00
XXXXXXXXXXXXXXXXXXXXX
 XXXXXXXXX
Order total
  
Mail to:

Dienharts German Gifts
P.O. Box 1189
Hinckley, Illinois. 60520
815-501-3821
Attach money order or check. Note: check orders will be held 10 days to ensure funds
Thank you for your order
Copyright 2005-2009  Dienharts German Gifts. All Rights Reserved.  
__________________________________________________________________________________