Order Form
Ordered By:                                                                       Ship to: (If different from Ordered by)
Name: _______________________________   Name : _________________________________
Address: _____________________________  Address: _______________________________
City: __________  State: _______ Zip: ______  City: ____________  State: _______ Zip: ______
Telephone __________________

            Make Checks Payable To: 

   David Clough Designs

            Mail All Orders To:

   David Clough Designs
   4 Concord Circle
   Cumberland Foreside,  Me.  04110

            To Place An Order By Phone, Or Fax: 

   (207) 781-2156