BUYER INFORMATION
Name:	______________________________	Print and mail to:
Address:	______________________________	NORTHEAST WREATH
City:	______________________________	PO Box 3
State:	______________________________	Livermore Falls, ME 04254
Zip Code:	______________________________	Fax to:	(207) 897-2966
Phone Number:	______________________________	Order by Phone:	1-877-597-3284
PAYMENT INFORMATION
Credit Card Number:	______________________________	Expiration Date:	____________
3-Digit Authorization Code (last 3 digits on signature panel): __________
Check or Money Order Total:	______________________________ (make payable to: NORTHEAST WREATH)

PRODUCT ORDER
Item Number	Product Description	Quantity	Price Each	Total
1.	_________________________________________	_______	__________	__________
2.	_________________________________________	_______	__________	__________
3.	_________________________________________	_______	__________	__________
4.	_________________________________________	_______	__________	__________
5.	_________________________________________	_______	__________	__________
6.	_________________________________________	_______	__________	__________
7.	_________________________________________	_______	__________	__________
GRAND TOTAL $				__________

GIFT SHIPMENT INFORMATION : (Please note, UPS does not ship to P.O. Boxes.)
Item Number(s)	(from above section): __________    Quantity: _______
Ship To Name:	______________________________________________________________
Delivery Address:	______________________________________________________________
City:	______________________________	State: _____________	Zip: _________
Gift Message:	______________________________________________________________________
	______________________________________________________________________
Shipping:	(Standard, Free shipping unless specified)      3-Day Select (+$25) ____     2-Day Air (+$45) ____
Item Number(s)	(from above section): __________      Quantity: __________
Ship To Name:	______________________________________________________________
Delivery Address:	______________________________________________________________
City:	______________________________	State: _____________	Zip: _________
Gift Message:	______________________________________________________________________
	______________________________________________________________________
Shipping:	(Standard, Free shipping unless specified)      3-Day Select (+$25) ____     2-Day Air (+$45) ____
Item Number(s)	(from above section): __________      Quantity: __________
Ship To Name:	______________________________________________________________
Delivery Address:	______________________________________________________________
City:	______________________________	State: _____________	Zip: _________
Gift Message:	______________________________________________________________________
	______________________________________________________________________
Shipping:	(Standard, Free shipping unless specified)      3-Day Select (+$25) ____     2-Day Air (+$45) ____

Orders can be placed through our website, by telephone, fax, or mail. Most major credit cards accepted.
Orders requiring expedited shipping methods cannot be made online.