Please complete each item and print out this page (use separate forms for each order). Mail it to us along with a check or money order for $5.00 for each Dual Name order payable to:

Pasquelle Productions
53-37 73rd Street
Flushing, NY 11378

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FIRST NAME IMPRESSIONS ORDER FORM--DUAL NAMES
(Note: Please do not request more than two names per order form!)

CUSTOMER INFORMATION

YOUR NAME:
YOUR  ADDRESS:
(street, city, state, zip code)
YOUR  E-MAIL ADDRESS:
YOUR  PHONE NUMBER:
SHIPPING INFORMATION
(If same as above, write "SAME".)
NAME:
ADDRESS:

INFORMATION FOR FIRST NAME IMPRESSION-DUAL NAMES
FIRST NAME #1:       BIRTHDAY (mo/day):
GENDER:
FIRST NAME #2: BIRTHDAY (mo/day):
GENDER:
RELATIONSHIP:
(siblings, couple, etc.)		 CHOOSE ITEM:
PAPER DESIGN:
(3 designs listed)

       PRINT OUT THIS FORM AND MAIL WITH PAYMENT!

Thank you for your order!

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