If you wish to place an order, simply print this form, fill in your order, and mail it with either a "Money Order" of "Certified Check" to us at:

Normand J. Bergeron
P.O. Box 61074
New Bedford, MA 02746
 
This will afford you immediate shipment of your merchandise upon receipt of payment.
 
If you wish to place an order through PayPal, simply click on the "Add to Cart" button located under the "Story" description of each cup plate.

Thank You!

Item No. Description/Name Quantity Cost Each TOTAL



12.00



12.00



12.00



12.00



12.00



12.00



12.00



12.00


Merchandise Total


                                          
     Shipping Total


                                        
  Insurance Total


                                         

                   TOTAL

  

Please include $3.50 per cup plate for S/H/P 1st class mailing or $5.85 for S/H/P Priority mailing depending on zip code. Exact cost will be provided upon request by email. Please include $2.70 per cup plate for optional insurance.
MA residents must include 5% Sales Tax.

PLEASE SHIP TO:
NAME
ADDRESS
CITY, STATE, ZIP
CUSTOMER'S E-MAIL
SIGNATURE