________________________________________________________   Mail to:
Name: First          Initial               Last               
                                                           JIPottery
________________________________________________________   1625 S Crescent Blvd.
Street Address (No PO Box)                                 Yardley, PA 19067

________________________________________________________   Please allow 2 to 5
City                State                ZIP               weeks for delivery.
                                                           Special orders longer
________________________________________________________
Daytime Telephone  Area Code    Number

SHIPPING INFO (Please fill in below if you want order sent to another address.)

________________________________________________________
Name: First          Initial               Last

________________________________________________________
Street Address (No PO Box)

________________________________________________________
City                State                ZIP

________________________________________________________
Daytime Telephone  Area Code    Number

Please complete all information accurately.
 _______________________________________________________
| ITEM / DESCRIPTION | COLOR | DESIGN | QTY. | PRICE   |
________________________________________________________
|                    |       |        |      |         |
________________________________________________________
|                    |       |        |      |         |
________________________________________________________
|                    |       |        |      |         |
________________________________________________________

                            MERCHANDISE TOTAL:_________|
							
              PA SHIPMENTS ADD 6% SALES TAX:_________|
			  
                    SHIPPING & HANDLING $15.00 
                    or 15% on orders over $100_________|
		   
                                        TOTAL:_________|
										
Please indicate method of payment:

       VISA & MASTERCARD & AMEX Available through PayPal 
	   (jinderbitzin@jipottery.com)
	   
	
	MONEY ORDER:____                 CHECK:____
Please make check out to: Joyce Inderbitzin Pottery
We do not accept C.O.D.'s and please do not send cash.
_________________________________________________________________    _________
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|    |___|___|
Card Number                                                          Expires

________________________________________ _____________
Signature                                Date