Mid_Night Pottery - Order Form

Mid_Night Pottery - SpongWare
Print Order Form

To ( Mail/Fax ) order your Mid_Night Pottery items, simply print out this form.
Please fill in your name and address, the quantity and style you wish to receive
Please mail your order to the address at the bottom,
make check out to Streamers Couuntry. Thank You

Name:______________________________________

Address: __________________________________

City: _____________   State/Province:________   Zip:__________   Country: ________

Phone: ______-______-_________    E-mail:__________________________________

  Method of payment:

 ___ Check or Money Order - Payable to Streamers Country(US funds only)

( Visa - Master - Discover )  Please Mark one
 ___ Credit Card - Account #________-________-________-_________ Exp.____/____ 

 AUTHORIZED SIGNATURE ______________________________________________

............................................................................................................
ITEM #       Description            QUANTITY         PRICE         

#_____       _________________________    ________       $________     

#_____       _________________________    ________       $ _______    

#_____       _________________________    ________       $________     

#_____       _________________________    ________       $________    

#_____       _________________________    ________       $ ________   

#_____       _________________________    ________       $ ________   

          Subtotal         _____________

          Tax              _____________  (6% CT residents)

     Shipping         _____________ 

      Total Amount due _____________
       (If sending check please email order for shipping charges)
       (we need your zipcode for 'distance' and total items for 'weight')

Send Check, Money Order, Visa, MasterCard or Discover Order to:
Streamers Country Ceramics
1 Hazelwood Dr.
Baltic, CT 06330
For more information, Showcasw@streamers.com

Mid_Night Pottery

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Mid_Night Pottery - SpongWare Print Order Form

Mid_Night Pottery - SpongWare
Print Order Form