Print Mail Order Form

PRINT AND MAIL ORDER FORM TO

Roberta Fuller

c/o Crystal Palace
Park City Mall
Lancaster, PA. 17603
717-293-7171

PLEASE PRINT ON FORM

        Name:_________________________________________________
        Address ___________________________________________________
        City____________ State_________ Zip Code______________
        Email Address_______________________________________
        Telephone__________________

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Shipping & Handling for Canada add $6.00 $_____________
Grand Total $_____________

Make Your Money Order Payable To: "Roberta Fuller"

All information is confidential, and is not shared with parties other than those involved in this transaction. Thanks for ordering from Lords-n-Ladies.com