the life of riley
ORDER FORM
STYLE NAME
REF No.
PRICE
QUANTITY
GIFT SERVICE
AMOUNT
DAISIES
R-01
$40.00
ENCHANTED GARDEN
R-02
$50.00
UNDER THE SEA
R-03
$45.00
FAIRY PRINCESS
R-04
SOLD OUT
TWINKLE STAR
R-05
$30.00
TOTAL
GST INC. IN TOTAL
Shipping charges to be added to the total price.
Please select your form of payment
Credit Card
Cheque
Money Order
Direct Bank Credit
* Do not give credit card or bank account details. We will phone you.
YOUR DETAILS
NAME
ADDRESS
EMAIL or FAX
PHONE
GIFT RECIPIENT DETAILS
(IF USING GIFT SERVICE)
NAME
ADDRESS
MESSAGE
SPECIAL INSTRUCTIONS
