Site hosted by Angelfire.com: Build your free website today!
  • MARSHA AND JOHN'S PLACE
  • P.O. BOX 1154
  • DECATUR, IL 62525
  • (217) 865-2213
  • e-mail: marshaandjohnsplace@juno.com
  • www.marshaandjohnsplace.com

    This is a printable order form for you to use. You may make a copy of this page to send by mail or fax.

    PLEASE PRINT CLEARLY IN BLOCK LETTERS
  • NAME______________________________
  • DATE____/____/____ ADDRESS:______________________________________________ ______________________________________________________
  • STATE:______________ ZIP__________
  • e-mail_____________
  • COUNTRY________________________
  • PAYMENT:Check____Money Order______
  • Visa__n/a_____-_______-______-_______
  • expiration_n/a___/____
  • Master Card__n/a_______-_______-________-_______
  • expiration _n/a_____/______
  • Signature_n/a______________________________

    _____DESCRIPTION_______|QUANTITY|_PRICE___|__TOTAL__ _________________________|________|__________|_________ _________________________|________|__________|_________ _________________________|________|__________|_________ Shipping and handling |_________ Total |_________