ORDER FORM                  
                                         
(                                                                                                                              Use this copy only if mailing your check)
                                                                                                                                           Click
Bag Qty for price or call.
(please print)                                                                                                                                                                                                                           
Date:--------------
Name: --------------------------------------------------------------------
Address:--------------------------------------------------------------------------------------------
(street)                                                      (state)    (zip code)
Phone#------------------------------------- Cell Phone# -------------------------
Email:-------------------------------------
Shipping Address:
Name:    ---------------------------------------------------------------------
-                        Address: -----------------------------------------------------------
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QTY
STYLE
SIZE
COLOR
PRICE
TOTAL
          $
           
           
           
           
           
           
                                       Total $_____                         
                          plus S/H $ ____
            GRAND TOTAL   $____                           
NOTE:
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Pali-Hawaii Sandals
Tel:  615-865-1709