Date_____________

Quantity of Cones @ $19.95 each/ Original Design___________ New Design___________

Shipping and Handling is FREE to U.S. residents

Subtotal__________________________

NY State Residents sales tax__________

Grand Total_______________________

Send Money Order To (No personal checks please) :

Rosenthal Pottery, 3 Lark Ct. , Old Bethpage, New York, 11804

Customer Information and Shipping Address:

Customer Name ______________________________________________________

Address ____________________________________________________________

City , State_________________________________ Zip Code__________________

Phone Number (include area code) ___________________________________

Email Address___________________________________________________

How did you find my web page? (Links, search engines.)_____________

Comments:__________________________________________________

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