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Printable Order Form

Your Name

Date

Your e-mail address

Daytime Phone

Evening Phone

Name

 Address

To pay with your Visa, MasterCard, or Debit card, click here.

Item#

Qty.

Description

Price Ea.

Total

Print this form and mail with Money Order or Personal Check made payable to: Perfect Reflections, P.O. Box 659, Santa Margarita, CA 93453. All orders MUST include payment, no C.O.D’s will be accepted.

For questions, e-mail us or call 805-438-3325, 9a.m. to 5p.m. Pacific Time.

©1999-2001  Perfect Reflections.com

Subtotal

CA Residents add 7.25% Sales Tax

Shipping ($4.55 for pens,$10 per fountain)

TOTAL
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