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NAME
PHONE
ADDRESS
CITY
HOSTESS
Polka Dots, Inc. 936 Market Street Fort Mill, SC 29708 www.polkadotsstationery.com
STATE
ITEM NAME:
Personalization
ZIP
PARTY DATE FONT 1: FONT 2:
PAGE #:
INK 1:
ITEM #:
INK 2: (+$6)
COLOR:
FABRIC:
SIZE:
RIBBON:
PRICE: $
THREAD:
QTY:
NOTES:
TOTAL: ITEM NAME:
Personalization
FONT 1: FONT 2:
PAGE #:
INK 1:
ITEM #:
INK 2: (+$6)
COLOR:
FABRIC:
SIZE:
RIBBON:
PRICE: $
THREAD:
QTY:
NOTES:
TOTAL: ITEM NAME:
Personalization
FONT 1: FONT 2:
PAGE #:
INK 1:
ITEM #:
INK 2: (+$6)
COLOR:
FABRIC:
SIZE:
RIBBON:
PRICE: $
THREAD:
QTY:
NOTES:
TOTAL: ITEM NAME:
Personalization
FONT 1: FONT 2:
PAGE #:
INK 1:
ITEM #:
INK 2: (+$6)
COLOR:
FABRIC:
SIZE:
RIBBON:
PRICE: $
THREAD:
QTY:
NOTES:
TOTAL:
TTL PG 2:
VISA / MC / AMEX / Check CC #
SALES
CHECK #
TTL, PG 1:
TAX: SH:
TOTAL DUE:
exp. date: 3-4 dig pin:
Shipping
up to $40
$9.95
Polka Dots Parties
& Handling
$41 - $80
$12.95
is a division of
$81 - $150
$15.95
Polka Dots, Inc.
$151 - $220
$18.95
Fort Mill, SC
$221+
$21.95
© 2010
internal use only