Epiphany House Fundraisers Order Form

Please print and complete this form, and mail with your check or money order to:

Epiphany House
1110 Grand Avenue
Asbury Park, NJ 07712

Item	Cost	Quantity	Total
Designs by Lucinda People Pin	$12.00
Designs by Lucinda House Pin	$12.00
Fleece throws / Stadium blankets	$20.00
		Sub-Total:
		Shipping 4.00 per item
		Total:

Color of Fleece throw / Stadium blanket: Gray Black Maroon

 

 

First Name: Last Name:

City: State: Zip Code:

Phone: - -