Order Form

	Loretta's Candles and Crafts
	210 WestBroadway
	Eagle Grove, IA 50533
	Phone 1-888-448-4451
	M-F 10-5, Sat 10-4 cst
	lcandles@goldfieldaccess.net

Billing To:

Name___________________________________________

Address_________________________________________

City__________________State________Zip____________

Daytime Phone ( )_______________________________

QTY.	SIZE	CUT STYLE	INSIDE COLOR(S)	OUTSIDE COLOR	DESCRIPTION	UNIT PRICE	TOTAL








Toll Free Ordering 1-888-448-4451 M-F 10-5, Sat. 10-4 CST E-mail lcandles@goldfieldaccess.net					SUBTOTAL
					TAX ADD 5%
					Shipping is $5.00 for first item, then 50 cents for each additional item
					TOTAL

Method of payment: ___ Money Order ___ Master Card ___Visa

Acount number for credit card orders:

__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration Date __ __ / __ __ Signature ______________________

Thank You For Ordering