Date ________________ Customer Name _____________________ * Street # or PO Box ___________________ * City ___________________ * State ___________________ * Zip Code ___________________ * Base Price Plain - $6/each - Number wanted ______ Basket Stamped - $11/each - Number wanted _____ Floral Tooled - $16/each - Number wanted _____ Options Dyed - Yes _____ (add $5/each) No _____ Filigree - Yes _____ (add $5/each) No _____ Silver - Yes ______ (add $6 each piece) No _____ Brand/Initials - Yes _____ (add $5/each) No _____ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total (# wanted x base price + all options) _______________ Due with order (50% of total) _______________ Due on completion (remaining 50%) _______________ Or Payment in Full _______________ | Phone number (___)______________ * E-mail __________________ * indicates a required field Dye Color: Black _____ Mahogany ______ Cordovan _____ Filigree Color __________________ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Print this page, mark desired options and send with cashier's check or postal money order for the amount at left to: Empire Leather Company Brett Buchanan, Maker PO Box 262 Durkee, OR 97905 |