ORDER FORM

Item: ____________________________________________Quantity:_______________
Color: __________________________Size:____________________________________
Price: ____________________________

Item: ____________________________________________Quantity:_______________
Color: __________________________Size:____________________________________
Price: ____________________________

Item: ____________________________________________Quantity:_______________
Color: __________________________Size:____________________________________
Price: ____________________________

Item: ____________________________________________Quantity:_______________
Color: __________________________Size:____________________________________
Price: ____________________________

Sub-Total: __________________________

Shipping charge______________________ (Add $5 if order is to be shipped)

TOTAL: _____________________________

Name___________________________________________________________________

Address:________________________________________________________________

City:____________________________State: ______________Zip:_________________

E-Mail Address:______________________________Phone________________________

Method of delivery: ( ) Drop off with student/school ( ) Ship to above address - Add shipping charges of $5 per order.

Method of Payment:

_____ Check Enclosed, made payable to RWJMS Association of Families & Friends

_____ Charge my credit card:  ___VISA  ____Mastercard    _____American Express

Credit Card Number_______________________________________________Expiration Date:_________

Signature:_____________________________________________________________________________

Send your order via email to stitches@aff-rwjms.org or mail to:

Sue Madurski
100 Hunter Avenue
Fanwood, NJ  07023

Questions:  Contact Sue Madurski at 908-322-7019 or Donna Herman at 856-424-2077.

Thank you for your valued order and continued support!