ORDER
"HEAVEN CENT"
Pennie Griff
P. O. Box 638
Trinidad, CO  81082

PLEASE PRINT OUT THE ORDER FORM, TOTAL, ATTACH YOUR CHECK OR MONEY ORDER AND
MAIL TO THE ABOVE ADDRESS.
MAKE CHECK PAYABLE TO:  Pennie Griff
UPON RECEIPT OF YOUR ORDER, I WILL CONFIRM YOUR ORDER VIA EMAIL


CUSTOMER INFORMATION 

NAME:_____________________________________ 
ADDRESS:__________________________________ 
___________________________________________ 
CITY:_______________________________________ 
STATE:_____________________________________ 
ZIP CODE:__________________________________ 
PHONE NUMBER:____________________________ 
EMAIL ADDRESS:____________________________ 
___________________________________________
SHIPPING INFORMATION IF DIFFERENT 

NAME:_____________________________________ 
ADDRESS:__________________________________ 
___________________________________________ 
CITY:_______________________________________ 
STATE:_____________________________________ 
ZIP CODE:__________________________________ 
PHONE NUMBER:____________________________ 
EMAIL ADDRESS:____________________________ 
___________________________________________
ITEM NAME
HOW MANY
PRICE EACH
TOTAL AMOUNT
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
PERSONALIZATION OR SPECIAL REQUESTS:
*
*
*
*
SUBTOTAL                                                        :_________________ 
SHIPPING and HANDLING CHARGE:                :_________________ 
TOTAL ENCLOSED::                                           :_________________
Shipping:  $5.00 for 1ITEM
Email me for additional postage on extra items.
Thank you for order!