Order Form

ORDER FORM

Please print this page, complete the information below and mail, along with a check for $20.00 US per screensaver, plus $3.00 each shipping and handling, TOTAL $23.00, to:

Alan Dabrowski

26 Market Street

Webster MA 01570

Make check payable to: Alan Dabrowski

A portion of the proceeds will be donated to the French River Connection

I enclose $___________ for _____________screensavers

My Name:___________________________________________________________________________

Street Address________________________________________________________________________

City______________________ State____________________ ZIP___________________________

Phone:________________________ Email________________________________________________

Currently shipping to the US and Canada Only

Thank you for your order. It will soon be on its way!