ORDER FORM
Please print this page.   Fill out the form and either mail it to us with payment or call for credit card orders.

CALICO JAM
PO Box 631
Naples, NY  14512

Credit Card Orders Call 1-585-534-5781

Ordered by Ship To
Name: Name:
Address: Address:
City/State/Zip: City/State/Zip:
Phone# Date
   

QTY.

FRAME COLOR

DESIGN DESCRIPTION

PRICE

TOTAL

SUB-TOTAL
Payment Method: _____ Check _____ Money Order _____ Credit Card

SHIPPING (20% of
sub-total)

  
Card # ______________________________  Exp. Date________
Card Type: _____ VISA _____ MASTERCARD _____ DISCOVER
                  _____   AMERICAN EXPRESS

NYS TAX

  
Signature   ______________________________________________ TOTAL  

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