ORDER FORM

NAME  

  ADDRESS  

  CITY      State      Zip  

  Phone         

  CLOWN BAG   $  29.95       COLOR      STYLE  

  VISA/MC #      EXP. DATE  

  COMMENTS: 

  CHECK or M.O. payable to   "FEATHERS THE FANCY CLOWN"

                                              1965 SW 25 Terr.

                                              Coconut Grove, FL 33133-2415

                                              phone/fax: (305) 285-9454