EMMR Gift Catalog Order Form

Print this form, then be sure to give complete descriptions & check your order.  
 IMPORTANT: Use the table at the bottom of the form to determine your Shipping Charges.

**SHIP TO**

Name:__________________________________________________

Street:__________________________________________________

City: _________________________ State:_______ Zip:__________

Phone:(_______)______________ e-mail:____________________

*Checks & Money Orders Payable To “EMMR”*

Check No._______________ Money Order No._______________

Visa/Master Card No.______________________Expires______

QTY.

Description & Size

$ Each

$ Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       
       
       
       
       

 

 

 

 

  Sub Total    
  SALES TAX 6%  [PA Residents Only]    
  SHIPPING CHARGES [See Below]    
  TOTAL REMITTED    

MAIL ORDERS TO: EMMR Gift Shop, c/o Joe Heisler 3rd, 27 Cottage Ave., Glen Rock, PA 17327

Contact Joe Heisler 3rd for shipping rates, jlh3@erols.com (410)303-4428