Insect Creations - Printable Order Form
Print this form for easy mail order.
Complete your order, send along with your check or money order to:


Brian Brenner
526 Georgetown Road
Ronks, PA 17572
 
610-613-4273

E-mail: 
sales@insect-creations.com

 
QTY ITEM # and/or NAME PRICE TOTALS
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Penssylvania Residents add 6% tax -                        
  Shipping  
TOTAL ORDER  
CREDIT CARD INFORMATION
Name on Card -
Card Number -
Security Code on back of card (last 3 digits)
Exp.date                                  CIRCLE ONE:   VISA     M/C  
CUSTOMER INFORMATION
Customer Name
Address
City                                                           State                      Zip Code
Home Phone #                                     Work Phone #                                      Email Address

All patterns and designs 2002 Insect Creations - ALL RIGHTS RESERVED
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