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PACER Center
952-838-9000

Champions for Children with Disabilities

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A.WHELIHAN FINE ART PRODUCTION Thyme Table

Please print this form, complete it, and mail or fax (952-838-0199) to PACER Center.
8161 Normandale Blvd.
Minneapolis, MN 55437

PACER BOTTLED SPRING WATER	Quantity	Total
___ SINGLE BOTTLE..................$1	_______	______
___ CASE OF 24..........................$12	_______	______

DINNERWARE	Quantity	Total
___ CHARGER............................$35	_______	______
___ SALAD PLATE.....................$12	_______	______
___ CUP........................................$10	_______	______
___ SAUCER................................$10	_______	______
___ 4-PIECE PLACE SETTING $59	_______	______


	Quantity	Total
___ APRON.................................$20	_______	______
___ COLLECTOR PIN...............$20	_______	______

PAYMENT METHOD	Grand Total: __________ (appropriate taxes are included in prices) (shipping and handling are not included)
Amount Paid: ________
___ My check, made payable to PACER, is enclosed for $________ ___Charge $________ to my VISA / MC / AMEX #_________________ Exp. Date__________ Name as it appears on your credit card:___________________________________ Name:__________________________(Last)_____________________________(First) Address:_________________________________(Street) ______________________________(City)________(State)_____________(Zip) Phone:___________________(daytime)___________________(evening)