Order Form

Item #

Price

Subtotal

Name:

Address:

(To ship merchandise if different from above.)

Home Phone:

Method of Payment

Money Order

MasterCard

American Express

Credit Card #:

For each item you want to purchase, enter the quantity in the appropriate box on the line describing the item.  Then multiply the quantity by the price and enter the amount in the subtotal column on the far right.  When you have completed your order, add up all the amounts in the subtotal column and insert the sum in the “Order Total” column.  Next, find the appropriate shipping amount from the shipping chart and place it in the “shipping amount” box.  Add this to your “Total Order” to find the “Total Amount Due”.

If you have a problem ordering, email us or call:  901-794-9540 or 901-412-6870.

If paying by check or money order, make payable to Girley R. Hines and mail to:  3085 Estes St., Memphis, TN  38115.  All payments (including checks and money orders) must be in United States currency (USD).  Note that checks must clear before any order is shipped.

E-mail:

Color

Description

701

Green and White Checked

Size

$27.00

301

Qty.

$35.00

302

$35.00

303

Purple with Fruit and Solid Lavender Bottoms

$35.00

101

Pink and Red Check

$27.00

101

Pink and Red Check

$32.00

201

White w/Black & White ck. trim

$38.00

201

White w/Black & White ck. trim

$48.00

601

Pink & White Polka Dot

$45.00

601

Pink & White Polka Dot

$55.00

401

Red & White Polka Dot with Red & Kelly Green Trim

$34.00

401

Red & White Polka Dot with Red & Kelly Green Trim

$40.00

501

Red with Black Ruffle

$34.00

.00

501

Red with Black Ruffle

$36.00

.00

702

$27.00

.00

702

$30.00

.00

701

Add Bows to this dress for $3.00 extra per dress.

101

Add Bows to this dress for $3.00 extra per dress.

301

Add Bows to this outfit for $3.00 extra per outfit.

Place An Order For Hair Bows

Description

Color

Qty.

Note that most bows allow for 3 different color selections.  If more than 3 different colors  are desired, please place a separate order or contact us.   Consult the Hair Bow Color Chart to see the exact colors of the bows.

901

Black and Orange Polka Dot

$6.50

911

$5.00

902

$6.00

904

$2.50

906-1

$1.50

906-2

905

$1.50

$1.50

903

$4.00

907

$6.00

908

$4.00

909

$2.50

910

$6.00

920

Christmas Theme Colors

$6.50

Shipping and Handling Chart

Add all subtotal columns to get   ORDER TOTAL >

Add appropriate amount from the Shipping and Handling Chart to the left.

SHIPPING >

TOTAL AMOUNT  DUE >

Visa

Discover Card

Expiration Date:

Month

Year

Cell or Work Phone:

(Name shown on credit card.)

Please enter any special instructions here.

Address as shown on credit card:

If order is:

Then Add:

$20.00 or less

$5.99

$20.01 to $30.00

$6.99

$30.01 to $40.00

$7.99

$40.01 to $50.00

$8.99

$50.01 to $60.00

$9.99

$60.01 to $70.00

$10.99

$70.01 to $80.00

$11.99

$80.01 to $90.00

$12.99

$90.01 to $100.00

$13.99

$100.01 to $200.00

$17.99

$200.01 to $300.00

$18.99

$300.01 to $400.00

$19.99

$400.01 to $500.00

$20.99

$500.01 to $600.00

$21.99

$600.01 to $700.00

$22.99

$700.01 to $800.00

$23.99

$800.01 and up

$24.99