Violet Maynard

Product Order Form

Please print this form, complete and send with your check/money order.

Name: ____________________________________________________________

Shipping Address: __________________________________________________

Please print or type.

City: ______________________ State: ___________     Zip: ____________

Daytime Phone: (___) __________            Evening Phone: (___) ____________

              Product               Price  Quantity    Total

Many Riches Have I - CD     $15.00  _______ $______

My Refuge - CD   $15.00  _______ $______

(1 = $15.00 or 2 = $25.00)

Subtotal:         _______

Please add shipping/handling:                $3.00

Total:        $_______

Make check/money order payable to: Violet Maynard

After completion, please send order form and payment to:

Violet Maynard and Family

Attn: Product Order

PO Box 272112

Columbus, OH 43227

(Note: You will not be contacted unless information is needed.)

Email Address: ____________________________________________________