PRINT THIS FORM!**Custom Ceramics by Tracey Order Form**

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT (please make check or money order payable to Custom Ceramics by Tracey) Custom Ceramics by Tracey PO Box 224 Stillwater, MN 55082 E-Mail: rubyk@winternet.com Back To The Showcase
Circle Payment Method: Check Money Order Visa MasterCard
Name:(print & signature)
Address:
City:	Credit Card Number:
State & Zip:	Expires:
Telephone:	Email address:

Item Name and Description	Price Each	Quantity	Total
Birthstone Bear (indicate month)	$7.49
Wolves - Mother with Pups	$48.99




Subtotal:
Shipping and Handling:
Minnesota Residents Please Add 6.5% Sales Tax:
Please allow 2 - 4 weeks for delivery.		Total :