PRINT THIS ORDER FORM AND MAIL WITH PAYMENT
(please make check or money order payable to Sherri Pierce)
Old Woman In Purple
16704 58th Place West
Lynnwood, WA  98037
phone: (425) 743-9775
email: Sherri@oldwomaninpurple.com

Circle Payment Method:          Check   Money Order

Name:(print & signature)
Address:
City:
State & Zip:
Telephone:

Item Name and Description

Price Each

Quantity

Total

Item A Original Purple Hair: Gray White Red Blonde Brown Black

$48.00

   

Item B Leopard Hair: Gray White Red Blonde Brown Black

$48.00

   

Subtotal:

 

Washington Residents Please Add 8.6% Sales Tax:

 

Please allow 3 - 4 weeks for delivery of out of stock items. In stock items shipped immediately.

Total :