JO-NA'S

GIFTS BY MAIL

11070 Emerson Road

Apple Creek, OH  44606

1-330-698-0441

Ship To: (Please Print)

Name: _________________________________________

Address:________________________________________

             ________________________________________

  (UPS willl not deliver to PO Boxes)

City: _________________________      State __________

Zip: ___________Phone (          ) _________________

                Product Title / Description                                         Price           Quantity            Total

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Shipping Chart

   0.01  -   15.99 ---------------   $6.25

  16.00  -   39.99 ---------------   $8.95

  40.00  -   64.99 --------------  $12.95

  65.00  -  109.99 -------------- $15.95

110.00  -  above  --------------  $19.95

  (Call for shipping outside 48 states)

Thank you for your order.

Print this form, complete, and send with check or money order to the above address.  Make checks payable to:

Jo-Na's Gifts by Mail.

Total            __________________________

Sales Tax (Oh residents add 6.25%)  __________

Subtotal    ___________________________

Shipping (see chart below)      ______________

Total  ______________________________