Date ________________ Customer Name _____________________ * Street # or PO Box ___________________ * City ___________________ * State ___________________ * Zip Code ___________________ * Base Price: Plain - $110 _____ Basket Stamped - $135 _____ Floral Tooled - $165 _____ Options: Filigree - Yes _____ (add $25) No _____ If yes, indicate filigree color __________________ Silver - Yes _____ (add $6 each piece) No _____ Initials/Brand - Yes _____ (add $15) No _____ Adjustable Strap - Yes _____(add $25) No _____ Clasp - Yes _____ (add $15) No _____ Pockets - Yes _____ (add $15) No _____ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total (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 Two piece _____ Three piece _____ Width __________ Height __________ Thickness ___________ Strap Length __________ Liner color _______________ Dyed - Yes _____ (add $25) No _____ If yes, indicate color: Black _____ Mahogany _____ Cordovan _____ Pen Holder - Yes _____ (add $5) No _____ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 |