Print this form, fill it out, and mail it with payment to: Small House Pottery, PO Box 158, Sanger, Texas 76266

SMALL HOUSE POTTERY ORDER FORM -- PLEASE PRINT
Item Design Code Quantity Price Total 1.           2.           3.           3.           4.           5.           6.           7.           8.           9.           10.
*Texas Residents add 8.25% Sales Tax Shipping: $12.00 for 1 item                 +$1.00 each additional item All shipments via UPS. Continental USA only. Sub-Total _______________ Texas Tax* ______________ Shipping ________________ Total ___________________
PAYMENT
Enclosed is a:              Check _____ Money Order _____ (Make checks payable to: Small House Pottery) Charge my credit card:              Visa ___     MasterCard ___	Card # ________-_______-_______-______ Expires ______________________ Cardholder Name _____________________ Signature ____________________________
SHIPPING Name: _______________________________ Address: _____________________________ City: ________________________________ State: ______________  Zip: _____________	ADDITIONAL INFO (will be used to confirm shipment date) Email: _______________________________ Phone: _______________________________ Fax: _________________________________