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    Item Number        Qty              Style     Price            Total
             
             
             
             
             
             
             
             
   
Special Instructions:       Subtotal:  
        Shipping: $1.59
         
         
      Total:  
       
   
 
    Mail Payment to: LighterCovers.Com P.O. Box 3218 Daveport Florida 33836  phone # 407.625.3507
   
Signed:       Date:    
   
             
   
 
   
We will inform you via email of the receipt of your order.
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We will send out your order within 5 days of receiving the above form 
  accompanied with your payment!