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| Poetic Wear Order Form |
| 87-50 204 th St. Suite A-22 Queens Village, NY 11423 |
| (P) 718-776-2229 |
| (F) 718-776-2229 |
| Email: poeticwear@yahoo.com |
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| Name____________________________________________ |
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| Address___________________________________________ |
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| Tel_______________________________________________ |
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| Email_____________________________________________ |
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| Put a Check next to item |
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| Baby To Be T-shirt __________ Kitty Love-T-shirt (Male)_________ |
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| Moment In Time Picture Frame________ Kitty Love T-shirt(Female)________ |
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| Poeticscope (Zodiac Poem)___________ |
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| Please indicate Size and color for t-shirts or your zodiac sign here: |
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| Send Money Order to Poetic Wear/Ware |
| 87-50 204th St. Suite A-22 |
| Queens Village, NY 11423 |
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| SHOPPING CART |
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