MidAtlantic Samoyed Rescue Order Form
Thank you for supporting MidAtlantic Samoyed Rescue. Your order will help us help more Samoyeds in need.
Ordered By:						Phone #
Street Address						Email
City, State, Zip
Ship To (if different than above)						Phone #
Street Address						Email
City, State, Zip
ITEM				Quantity	Price Each		Total
DIGGER					$100.00
EMBROIDERED POLO SHIRTS
	Black		___ S ___ M ___ L ___XL		$25.00
	Purple		___ S ___ M ___ L ___XL		$25.00
MASR T-SHIRTS		___ S ___ M ___ L ___XL			$10.00
Order Total
Print this order form & mail it along with a check made payable to MidAtlantic Samoyed Rescue for the appropriate amount to: MidAtlantic Samoyed Rescue Attn: Jeanne Johnson 2450 Johnson Rd Huntingtown MD 20639