MEANWHILE BY MARY

order form for our headware apparel.

 
First Name : ______________________________ Last Name : ______________________________
Mailing Address : ______________________________ City : ______________________________
    Zip Code : : ______________________________
Day Phone : ( _____ ) _____ - __________ Evening Phone : ( _____ ) _____ - __________
       

Apparel Headware Combo (Fabric and Bangs) Orders
Price Fabric Description (Set and Position) Number Total Price (Price x Number)
$32.00 Style Set # : _______  Left - Right - Top - Bottom __________ $ _________ . _____
  Number of Bang Pieces : ______    
  Color # for Bang Pieces from Chart : ______    
  Are You Sending a Sample of Your Hair ? (YES - NO)    
  Adult 7 1/2" : ______   Child's 6" : ______    
       
Apparel Headware sold seperately
Price Fabric Description (Set and Position) Number Total Price (Price x Number)
$17.00 Style Set # : _______  Left - Right - Top - Bottom __________ $ _________ . _____
  Adult 7 1/2" : ______   Child's 6" : ______    
  May we substitute a similar fabric? : ( YES - NO )    
       
  Sub-Total $ _________ . _____
  Shipping & Handling (refer to Ordering Information) $ _________ . _____
  6% Sales Tax (Indiana Residents Only) $ _________ . _____
  Total $ _________ . _____
     
  Please Print this form and send via snail mail with check payable to:  
 

 

MEANWHILE

11147 S. Orange Loop

Brookston, IN 47923
 

You may use the back of this form for any additional notes you would like to provide.  Please include Child's head circumference from hairline to nape over ear tips & bang to nape across top of head.  Please call for latest children's prints.
  Check Preference : ________ Cancer Research                 __________ Breast Cancer Research