NEW.......You can now fill out a form and send it to us electronically.
We will email you with a confirmation message when we receive it!!
If you are unable to use the electronic submission just print out this form
and mail it to us and we will contact you with the total amount due.
Mike and Karen's Custom Design
5758 West Henrietta Road
West Henrietta, NY 14586
Name: ______________________________
Address: ____________________________
City: ________________________________
State: _______________ Zip: ____________
Phone: ______________________________
Email Address: ________________________
Shipping Address (Only if different from above address)________________________
__________________________________________________________________
Item:
* 1.55oz Hershey Wrapper: _______
* 1.55oz Hershey Wrapper with candy bar: _______
* 2 liter Cola Bottle Wrapper: _______
* 12oz Cola Bottle Wrapper: _______
* Champagne/Wine Bottle Wrapper: _______
Quantity needed: _____
Date needed by: _____________
Photo included? Y/N (CIRCLE
ONE)
Release enclosed? Y/N (CIRCLE
ONE) + (Photographer
release is required for the use of professional photos)
Would you like a sample emailed to you before we print your final order? Y/N
(CIRCLE
ONE)
Event:
Directions: Please check the event that you would like your wrappers/labels made for. Then fill in the appropriate information below that you would like to have displayed on the wrapper or label.
Wedding _____
Anniversary _____
Birthday _____
Birth Announcement _____
Baby Shower _____
Graduation _____
Wedding Shower _____
Retirement _____
Engagement _____
Rehearsal Dinner _____
Business Advertisement _____
Real Estate _____
Holiday _____
Baptism/Confirmation _____
Other _____
Style
Name:
_____________________________________ example: (BABY
GREEN FRONT) & (BABY GREEN BACK)
- ALL graphics and sayings are
interchangeable between the wrappers to meet your needs.
Name(s): _____________________________________
_____________________________________
_____________________________________
_____________________________________
Date of Occasion: ______________________________
Date Married: _________________________________
Anniversary Date: ______________________________
Birth date: ____________________________________
Age: _________________________________________
Weight: ______________________________________
Length: ______________________________________
Due Date of baby: ______________________________
Names of Parents/Siblings: _______________________
______________________________________________
______________________________________________
______________________________________________
Name of School: ________________________________
Color scheme: __________________________________
Special sayings: ________________________________
_______________________________________________
_______________________________________________
Special instructions: _____________________________
_______________________________________________
_______________________________________________
Other: _________________________________________
_______________________________________________
Orders are usually shipped within two weeks after ordered. Birth announcements are given priority and are shipped within one week after order. For orders over 300 we recommend at least a
month notice. Express shipment is available for an additional fee. Orders are not processed until payment is received in full.
If you have any questions please email me at
Info@mikeandkaren.cc
or call us at (585-334-6454).
