Order Form for
The Loft at Meadowbrook
Name:______________________________
Mailing Address: ______________________________
City, State, Zip Code:______________________________
Daytime Telephone:______________________________
Billing Address: (if different from above)______________________________
Item Description:______________________________
Item Color(if applicable):______________________________
Monogram Style/Color/Placement (if applicable):______________________________
Size:______________________________
Price:______________________________
Quantity:______________________________
Payment Method:___________ Check___________ Visa/MC Card
Card Number:______________________________
Exp. Date:______________________________
Signature:______________________________
Shipping/Handling: If merchandise totals $0-$100, please add $5; $100-$200, please add $10; if your order is over $200, please add $15. _____________________________
Note: If you live in Maryland, please add sales tax of 5%.
Total for this order:_____________________________