Prairie Textiles Order Form

You can print this order form and mail or Fax it to Ann Wallace and Friends, or order by phone.

Ann Wallace & Friends
Box 2344
Venice, CA 90294
Voice 213-617-3310
Fax 213-617-3304

Item#	Quantity	Description	Color	Price
			Subtotal
			Shipping and Handling
			Total

Please charge my Mastercard/Visa (circle one).



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card number                         expiration date


___________________________________________________
name


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street                                         apt.


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city                                 state      zip

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TELEPHONE 213-617-3310