ASSA RESCUE ORDER FORM
INCOLAY
PO Box 3519
Gardena, CA 90247
Call 1-800-INCOLAY (462-6529)
ORGANIZATION SOLD TO
Your Organization:
Select Your Organization
The ASSA
Arizona Sheltie Rescue Inc
Colorado Sheltie Rescue
Greater Detroit Sheltie Rescue
Heart of KY Sheltie Rescue
JacksonvilleSheltie Rescue
Kennebec Valley Shetland Sheepdog Club & Rescue
Long Island Shetland Sheepdog Rescue
Michigan Sheltie Rescue
Mid FL Sheltie Rescue
NorCal Sheltie Rescue Inc
Northern Chesapeake Sheltie Rescue
Northern Virginia Sheltie Rescue
Northwest Alabama Herding Dog Rescue, Inc
Precious Secrets Sheltie Rescue
Sheltie Haven Sheltie Rescue, Inc
Sheltie Rescue of East Tennessee, Inc
Sheltie Rescue of Georgia, Inc
Sheltie Rescue of Utah
SheltieShack Rescue of Kansas, Inc
Sheltie Zen Rescue
Shetland Sheepdog Placement Svs. of NJ
Southern Ontario Sheltie Rescue
Your Name:
Your Phone #:
ORDERING INFORMATION
Please
enter
quantity:
Description
Price
(each)
BLUE
$75.00
GREEN
$75.00
ONYX
$75.00
GARNET
$75.00
SARDONYX
$75.00
ROSE QUARTZ
$75.00
NAVY
$75.00
AMETHYST
$75.00
LILAC ROSE
$75.00
Red/White/Blue
$75.00
MARBLE
$75.00
TURQUOISE
$75.00
VANILLA
$75.00
DUSTY ROSE
$75.00
TOTAL
Shipping Charges:
Select One
1 Urn - $13.95
2 Urns - $25.95
3 Urns - $35.95
4 Urns - $39.95
5 and up - CALL FOR QUOTE
Payment Method:
Select One
Charge the credit card on file
I will call Incolay to pay
Please call me for payment
I will mail a check
The ASSA Foundation
I will pay via Paypal to gerrischmidt@earthlink.net
Ship To:
Address:
City:
State:
Zip:
Comments or Special Instructions:
Your Email Address:
Confirm Email:
It may take several seconds to process your order.
Please be patient and do
not
press the Submit button more than once.
