Send all orders to:   Marla's Palette   112 Penny Lane   Sycamore, IL 60178   (815) 899-4021   (815) 899-5021 FAX

Date:   Customer No.:   P.O. No.:   Date Shipped:   Terms:   Order Date:

Sold To:		Ship To:
Name:		Name:
Address:		Address:
City/State/Zip:		City/State/Zip:
Phone:		Phone:

Qty	Item Description	Item Number	Color	Price Each		Total Price
Merchandise Total
Shipping
Sales Tax - ONLY Illinois residents must add 6.75% sales tax
Order Total

Shipping Costs: $50.00 or less: $5.50 $50.01 to $100.00: $7.50 $100.01 to $200.00: $10.50 $200.01 to $300.00: $13.50 $300.01 to $400.00: $16.50 orders over $400.00: $20.00 Sales Tax: ONLY Illinois residents must add 6.75% sales tax

Terms: Please make checks payable to Marla's Palette.

To Place an Order: Mail to...   Marla's Palette   112 Penny Lane   Sycamore, IL 60178   (815) 899-4021 or Fax to...   (815) 899-5021