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Ship To:		      
First Name Last Name
Address City
State            Zip      
Bill to:      
First Name Last Name
Email Daytime Phone
Payment Method Check
Money Order		 Visa
MasterCard		 Credit Card #
(if mailing)
      Expiration Date

Item#/Description

 Size Color Crystal
design		 Embroidery
Design		 Transfers Item Price Design Price Total Price

Subtotal of Items
Personalize with name add $5.00 (include name in comments area)
Postage (see chart below)
Adjusted Subtotal
If shipped to Michigan add sales tax (6%)
Order Total

Comments and Additional Instructions:

Completed Forms: Shipping Rates:
Please mail completed order forms along with check or For orders with the continental United States:
Money Order to the following address:          
        $0.00- $20.00= $5.95
RosEirann Embroidery       $20.01- $35.00= $7.95
17100 Hannan Rd.       $35.01- $50.00= $9.95
New Boston, Michigan  48164       $50.01- $75.00= $11.95
        $75.01- and over $13.95
      For orders outside of the continental United States please contact us by phone or email

After submitting your order form, return to this page to pay using PayPal button below.

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