Emily's Gifts Secure Order Form

Contact Information:

Name:

Address:

Address:

City:

State/Province:

Zip Code:

Country:

Phone Number:

Email Address:

 Item Number: if available

 Item Quantity

 Item Description

 Price Each

 Total Price:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merchandise Total 

 

Michigan Residents Add 6% Sales Tax

Sales Tax

 

 

Shipping 

 

 

TOTAL AMOUNT DUE

 

Credit Card

Credit Card Type:

Credit Card Number:

Expiration Date:

Name of Cardholder:

Check or Money Order

If paying by check or money order, send payment to:

Emily's Gifts
4841 W. Milett Road
Fowlerville, MI 48836