Order Form

Please print and fill out, and send along with your check or credit card information to:
W. Eugene Burkhart, Jr.
P.O. Box 407
Blandon, PA 19510

When ordering Pressed Flower Wedding Invitations, please send wedding invitation and color choices for plant material.

Name: _______________________________________________________
Address: _______________________________________________________
City: _______________________________________________________
State: ___________
Zip Code:
 
_______________________
 
Item# Description
 
Frame Color
(Gold, Oak
Walnut, White & Silver)
Mat Color: Price
Please note: White frame is available for Original designs only.
Silver frame is available for Wedding Invitations only.
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
___________ _____________________________________ ___________ _______ ___________
  Sub-Total:   ___________
  Tax (if in PA:)   ___________
  Shipping (Please add 20%):   ___________
  Grand Total:   ___________
Payment: Check
Make checks payable to:
W. Eugene Burkhart, Jr.
P.O. Box 407
Blandon, PA 19510

Visa    MasterCard

Credit Card Number: ____________________________________________
Exp. date: ____________