Print this form and send with a check or money order to:
Rusti Kelley
36222 SE 46th St.
Fall City, WA 98024
| Quantity | Pattern Name | Price
Each |
Total | |
| _______ | Angel With Bear | 5.00 | _______ | |
| _______ | Angel With Deer | 5.00 | _______ | |
| _______ | Beach | 5.00 | _______ | |
| _______ | Emporer Dragon | 5.00 | _______ | |
| _______ | Golden Gardens Sunset | 5.00 | _______ | |
| _______ | Deception Pass | 5.00 | _______ | |
| _______ | Mount Rainier With Flowers | 5.00 | _______ | |
| _______ | Seagull | 5.00 | _______ | |
| _______ | Woodpecker | 5.00 | _______ | |
| _______ | Dahlia | 5.00 | _______ | |
| _______ | Lilies | 5.00 | _______ | |
| _______ | Butchart Fountain | 5.00 | _______ | |
| _______ | Angel With Buffalo | 5.00 | _______ | |
| _______ | Dragon With Maiden | 5.00 | _______ | |
| _______ | Native American Lovers | 5.00 | _______ | |
| _______ | In The Beginning | 5.00 | _______ | |
| _______ | Two Unicorns | 5.00 | _______ | |
| _______ | Dragon's Castle | 5.00 | _______ | |
| _______ | Gryphon's Pride | 5.00 | _______ | |
| _______ | Three Angels | 5.00 | _______ | |
| _______ | Dragor | 5.00 | _______ | |
| Shipping | ||||
| _______ | Total Patterns | x 1.00* | _______ | |
| Grand Total | _______ |
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