Brush N Up - ORDER FORM Hit "Print" on your browser, complete form, then mail to: DENISE ANGOTT-SMYCHYNSKY Brush N Up 30510 Manse Street, Harrison Township, MI 48045 586-465-5773 or denise@brushnup.com for any questions. How did you hear about Denise?_______________________________ DATE NEEDED: _____________________ Your Address and Phone Number: ___________________________________ ___________________________________ ___________________________________ SHIP TO:($12 Charge for shipping) ___________________________________ ___________________________________ CIRCLE: Plate / Tile / Platter House Platter $245/Boat or Car $155/Wedding $100/Pet $145 DEPOSIT REQUIRED : $85.00 (Non-refundable) (Circle if you want to include) Plate Stand $10 to $25 Personalized Message on back of plate:_______________________________ Tax:_____________ (6% Michigan Sales Tax) Total Due: ____________ Balance Due Upon Completion:___________ When Mailing Your Order, Please Make Sure You Have Included: This Form 3-5 Photos Deposit Check Payable to "Denise Smychynsky" THANK YOU FOR YOUR ORDER!