Order Form
Date:.........................
Name:...................................................
Address:...........................City:....................State:.....Zip:.....
Telephone number:........................
e-mail address:............................
Bandana Halter Tops
Quantity:.......
Color......................
Quantity:.......
Color......................
Quantity:.......
Color......................
Quantity:.......
Color......................
Halter Top $18.each..........................
Backless Top $28. each.......................
+Shipping $3..............................
orders over 3 Qty.Halters $1. each...........................
Total $......................................
Make check payable to: Elaine DeRosa
Mail to: Elaine's Originals
29 Rancho Road
Tustin, CA. 92780