Name:     First:      Last:

Address: 

City:                    State:

Zip:           Area Code and Phone:

Email:     

(if you are purchasing a Gift Certificate for a friend or relative, skip this section.)

Includes same product and services for gowns 11 feet long or less.
When this option is selected, no additional gown information is required.
Gift certificate will be sent to the name and address indicated at the
top of the order form.

Cleaned and sealed in a lined 5 gallon lithographed container filed with
argon gas, return shipping included with $1000 insurance.

Cleaned and sealed in a lined 14 gallon white container filled with argon gas,
return shipped included with $5000 insurance. You may have your local artist
airbrush this or you may have one of our artists quote this additional service
for you. See Options.

Plain white (non-lithographed) 5 gallon container: (Less $10.00)
Additional insurance. (Adds $1 per $100.00)
      Please indicate amount of additional coverage:$

This is the ultimate in personal expression and customization. Quote is based
on pictures or design concepts submitted. Prices range from $175 - $500
depending on complexity and amount of detail. Please contact us directly
regarding this service. You will not be disappointed.

Return shipping $0 - (Included anywhere in mainland USA.)
Hawaii/Alaska ($32.50 will be added)

VISA      Mastercard       AMEX       Money Order
Michigan resident (6% State tax applicable)
Card Number: 
Expiry Date: