Camellia Cottage Order Form

Camellia Cottage Order Form

Please allow up to 4 weeks for delivery

Print this order form out and send with your check or money order

We cannot proceed with your order until we have received payment in full

We Accept Checks or Money Orders

Please Send To:

723 Bicentennial Boulevard
Dover, DE 19904

Please Make Checks Payable To Georgia S. Renck

Placing a special order? Be sure you have already discussed that order with me.

Special Order #___________

Ordering Information

Street Address:___________________________________
City________________ State______ Zip Code ____________

Daytime Phone #______________ Evening Phone #_________________

Either use the back of this order form, or attach a document describing the information you want placed upon your order.

Items Ordered

Item Quantity Price Per Item Total Price

(1) # $ $

(2) # $ $

(3) # $ $

(4) # $ $

(5) # $ $

If ordering via a special order, please place cost we quoted here$_________

Shipping & Handling

Order Size Standard Mail Priority Mail

Under $50.00 add $3.95 add $5.95

Between $50 - $100 add $4.95 add $6.95

Over $100.00 add $5.95 add $7.95

Total Order(including shipping and handling) $__________

Item	Quantity	Price Per Item	Total Price
(1)	#	$	$
(2)	#	$	$
(3)	#	$	$
(4)	#	$	$
(5)	#	$	$

Order Size	Standard Mail	Priority Mail
Under $50.00	add $3.95	add $5.95
Between $50 - $100	add $4.95	add $6.95
Over $100.00	add $5.95	add $7.95