Memory Bears Order Form
Phone-(717)292-6046 E-mail- joesmemorybears@hotmail.com
Name __________________________________________
Address________________________________________
Phone#________________E-mail____________________
Date__________Date needed by____________________
Clothing being used______________________________
_______________________________________________
In Loving Memory of______________________________
Size:
#
desired
$total
Large-
$35/bear
_________
$_________
Small-
$30/bear
_________
$_________
Add $5/bear shipping within the USA $_________
Total amount-$__________
Mail to:
Janet Keller
4351 Schoolhouse rd.
Dover, PA 17315
___ paid __cash __check
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