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Blomenberg Studio
1627 336th Rd
Seward, Nebraska
USA 68434
Phone #: 402-643-4838
http://blomenbergstudio.com/
Email: Susan Ann Blomenberg
Name_____________________________Address__________________________
City__________________ State________________ Zip Code _____________
Phone # _______________ E-mail _____________________
City__________________ State________________ Zip Code _____________
Phone # _______________ E-mail _____________________
Circle Payment Method:
Check
Money Order
__________________________________________________________________________
| item number |
item name |
quantity |
price |
| subtotal |
|
| shipping & handling 1-2 items $10.00 3-4 items $20.00 |
|
| Nebraska Residents must
add 5.5% sales tax |
|
| Total |
MAKE CHECKS PAYABLE TO:
Susan Ann Blomenberg