OSTFRIESEN TEA & PORZELLAN SHOP
15802 N. Ave
Holland, IA 50642
Phone/Fax 319/824-3774


Name       ________________________________________________
  
Address 1  ________________________________________________

Address 2  ________________________________________________

City       __________________________ State/Zip ___________



Date       _____________

Comments   __________________________________________________________________

           __________________________________________________________________

Description               _   Style/Type             Quantity  Cost Each        Total

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

_____________________________ ______________________ _________ __________ ___________

                                                       Amount of Purchase ___________

                                        7% Sales Tax(Iowa Residents Only) ___________

                                                                Shipping* ___________

                                                    Total Amount Enclosed ___________ 

*Shipping:  Calculate about 15% on Porzellan, tea, etc. -
            Add $3.55 on 500 gram Kluntje & $4.64 on 1000 gram Kluntje

Any postage not used will be returned in separate envelope.