| Customer
Name:_________________________________ |
| Address:_________________________________________ |
| City:_______________________State:________________Zip:________ |
| Telephone
# :_____________________________________ |
| Email
Address:___________________________________ |
| |
| Occasion:_______________________________________ |
| (Wedding, funeral, etc.) |
|
| Price
& Sizes |
|
Candle Size: |
2 3/4" x 3
1/2" |
3" x
7" |
6" x 6" |
|
Price: |
$18.00 |
$28.00 |
$50.00 |
| Quantity of Candles
Requested: |
______ |
______ |
______ |
| (Prices do not include Tax &
Shipping) |
|
(standard)
|
|
|
| Special
Request for Candles:__________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| Bottom
Label:_______________________________________________________ |
| ____________________________________________________________________ |