Order by Mail - Just print form, fill out, and drop in the mail.

Name:_______________________________________________________

Shipping Address:______________________________________________

City/State/Zip:_________________________________________________

Please fill in one of the following if you wish an order confirmation:


Phone:___________________________      E-mail___________________________


QTY        ___Item Name & Number                              ______PRICE PER ITEM           TOTAL    

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________

_____       ___________________________________      _________      _________
                                                                                         
                                                                                          SUBTOTAL     _________
                               
                                                                                          SHIPPING        
 FREE!

                                                     Shipping Insurance (if desired)     _________

                                                                               
*GRAND TOTAL   _________
                                                                           *Please pay this amount.

Please send order form and payment to:

Victoria Heilshorn Studio
P.O. Box 283
Paulding, OH  45879  
  

                  
                     (Please use more than one form if more space is needed)

                                                                Thank You!