Order Form

Ste. Anne Gift Shop

Item Description	Size	Color	Quantity	Price
X	X	X	X	X
X	X	X	X	X
X	X	X	X	X
X	X	X	X	X
X	X	X	X	X
X	X	X	X	X

Shipping Charges

Up to $10.00	add $2.00
$10.01 - $19.00	add $4.00
$19.01 - $30.00	add $6.00
$30.01 - $40.00	add $8.00
$40.01 - $50.00	add $10.00

Merchandise Total Amount:	XXXXXXX
Shipping Charge:	X
Grand Total:	X

Make checks payable to Ste. Anne de Detroit

NAME:	X
MAILING ADDRESS:	X
CITY:	X
STATE:	X
ZIP:	X
PHONE:	X

or
Credit Card Information

VISA/MASTERCARD #:	X
EXPIRATION DATE: (xx/xx)	X
SIGNATURE:	X

Mail this form with payment
or credit card information to:

Ste. Anne de Detroit
1000 Ste. Anne St.
Detroit, MI 48216