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The St. Luke's Cap Charm |
| Available in Silver for $55 or Gold for $95. Cost includes tax and shipping. Please print out this page, fill out the information and return form and check to: 348 Emerson Road Longmeadow, MA 01106 Checks should be made out to Marieke N. Burt. If you have questions call (413) 567-1392 or email marieke@verizon.net. |
| ______________________________________________________________________ Description (Silver or Gold) Number Unit Cost Total Cost Check enclosed in the amount of ___________ ______________________________________________________________________ Your First Name Last Name Street Address __________________________________________________________ City and State ________________________________________ Zip _______________ Contact Information (phone or email) _______________________________________ |
