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HOW TO ORDER - HAND PAINTED DECORATIVE FLOOR CLOTHS

Print this page and mail your order to:

Elizabeth Kohli  (Maximillian's)

33335 Irongate Drive

Leesburg, FL 34788

Phone  (352) 293-8354  -  e-mail:  ekohli@comcast.net

ORDERED BY:

Name___________________________________

Addr. ___________________________________

City ____________________________________

State _______________ZIP _________________

Phone (   __  ) -    __   -             __

*e-mail __________________________________

SHIP TO:

Name  _____________________________

Addr.  ______________________________

City  _______________________________

State  ______________ZIP _____________

*(I will e-mail an order acknowledgement &

shipping notice)

QTY      ITEM #                  UNIT PRICE   TOTAL PRICE

____    ______                 _________    ___________

____    ______                 _________    ___________

____    ______                 _________    ___________

____    ______                 _________    ___________

                                           

                                             SHIPPING   ___________

                                                                                      

    ORDER TOTAL  $___________

PAYMENT:    _____ Check Enclosed (Make check payable to: Elizabeth Kohli)

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