Functional Pottery Order Form Page 1 of 2
Item H&W Price Pattern How Many Total Price Platter 13 1/2 " $70.00 Oval Platter 16" x 11" $48.00       Serving Plate 11" $42.00 Canister Small 7" $36.00 Canister Medium 8 1/2" $48.00 Canister Large 9 1/2" $62.00 Canister X Large 10 1/2" $78.00 Creamer 4 1/4" x 3 1/2" $16.00 Sugar Bowl 4 1/2" x 4" $24.00 Large Pitcher 8" $35.00 French Butter Dish 4 1/2" x 4 1/2" $26.00 Salt & Pepper 4" $25.00 Utensil Jar 7 1/4" x 5 1/2" $35.00 Spoonrest 5" $10.00 Small Plate 6" $10.00 Medium Plate 8 1/4" $20.00 Large Plate 10 1/4" $30.00 Soup Bowl 7" x 2 1/2" $15.00 Dessert Bowl 6 1/2" x 2 1/4" $12.00   Total $
Item H & W Price Pattern How Many Total Price Tea Pot 8" Holds 4 cups $50.00 Coffee Mug 4 1/4" x 3 1/4" $15.00 Chip & Dip Bowl 10" x 3" $38.00 Pasta / Chip Bowl 12 1/2" x 2" $55.00 Small Serving Bowl 8" x 2 3/4" $22.00 Medium Serving Bowl 9 1/2" x 3 1/2" $32.00 Large Serving Bowl 10 1/2" x 4" $55.00 Condiment Bowl 7 1/2" x 3" $30.00 Berry Bowl 7 1/2" x 3 1/2" $30.00 Drain Plate for Berry Bowl 6 1/2" $11.00 Small Bowl 5" x 2 1/2" $11.00 Soup Mug 5 3/4" x 3" $16.00 Mini Pie Dish 7 1/4" x 1 1/2" $16.00 Pie Dish 10" x 2" $32.00 Small Casserole 7 1/2" x 3" 1 qt. $38.00 Medium Casserole 9" x 4" 1 1/2 qt. $55.00 Square Baker 8" x 8" x 3" $32.00
				Functional Pottery Order Form  Page 2 of 2
	Ship To: Name:  ____________________________  Street: _____________________________ City & State: ________________________  Zip Code: __________________________ Phone: (___) ________________________  Order Date:_________________________ Bill To:  Omit if same as above Name:  ____________________________  Street: _____________________________ City & State: ________________________________________ Zip Code: ___________ Phone: (___) ________________________                   Order Date:________________
						Sub Total:__________ Sales tax: MI res. add 6%      __________ Shipping: Min.$9.00 or 10%      __________ Total:        __________
		Form of payment: Enclosed is my check or money order for $__________ Please make payable to: Prairie Springs Pottery Visa___ Master Card ___Credit card No. _ _ _ _ _ _  - _ _ _ _ _ _  - _ _ _ _ _ _ - _ _ _ _ _ _   Expiration Date: _ _ _ _ _ _                          Mail to: Prairie Springs Pottery 5240 E. Reading Rd. Osseo, MI 49266. Please allow 6 to 12 weeks for shipping, especially on special orders.   Please Note! We accept Master Card and Visa only. We are unable to process credit card sales on-line.  We ship via U.P.S.   If your merchandise arrives  damaged, please save the original carton and packing materials and notify us within five (5) days and we will send you a replacement.