Montage/Double Take
110 S. Railroad Ave.
New Holland, PA 17557
Phone:  717-917-1536   Fax:  717-354-6850 or 717-354-5557

Group Name __________________________

Style Chosen:____________ Color: _______________
          

 PLEASE PRINT NEATLY BELOW.

Size I would like to Order:________________    Size I wear:____________

Notes:_________________________________________________________
_______________________________________________________________
_______________________________________________________________

Name:__________________________________________

Address: ______________________________________________________

City/State/Zip Code: _____________________________________________

Phone Number: (preferably Cell phone):___________________________

Email Address:_________________________________________________

DRESS PRICE (TO BE FILLED OUT BY GROUP LEADER) $__________

* WE CANNOT ACCEPT CREDIT CARDS FOR GROUP ORDERS, UNLESS PAYING FULL PRICE FOR OUTFIT.