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Your Name: _________________________________________________________________________________ Is this a gift (circle one): YES NO If this order IS a gift, would you like it giftwrapped (extra $1): YES NO Your Address: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Your E-Mail: ________________________________________________________________________________ Number of Framed Collages w/Card Ordered __________________ (at $12 each) Number of Unframed Collages w/Card Ordered __________________ (at $6 each) Number of Framed Collages without Card Ordered ___________________ (at $10 each) Number of Unframed Collages without Card Ordered __________________ (at $4 each) What pictures and quotes would you like to get: __________________________________________________ __________________________________________________ ________________________________________________ ________________________________________________ What would you like written in your card or cards: __________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ __________________________________________________ Other Instructions: ____________________________________________________________________________ ____________________________________________________________________________ Total Cost for Pictures:_________________________ Shipping (optional): __________________________ Giftwrap (optional): _________________________ Total Donation: _____________________________________ Payment Made By (circle one): Cash Check Money Order Paypal |
| Brian Littrell From the Heart Fundraiser Order Form |
| Choices for pictures are: Flower, Cross, 2 Hands grasping each other, Heart, or Animal of your choice |
| Choices for quotes are: Family quote, Friendship quote, Love Quote, Loss of Love Quote, Missing you Quote, or Earth Quote |
| Click HERE to go back to previous page *NOTE: if you don't have a printer, that's fine! Just make sure to include a note with all information* Please e-mail me at KhityKat@aol.com before sending payment. Also, if you'd like to pay via paypal, please e-mail your order. You will be e-mailed when I recieve your donation. Payment can be made out to Amanda Nelson OR Just Within Reach. If you are including money to help pay for shipping costs, or if the item is being gift wrapped, please make checks/money orders out to Amanda Nelson. Please send payment to the following address: Amanda Nelson 17407 Ironwood St. Arlington, WA 98223 Thanks for helping GBB and BLHHCFC! |
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