Please fill out the order form below, print and mail
with your check or money order to:
Ernest K. Schwartz
6807 S 300E
Berne, IN  46711

Name: 

Address: 

City:    State:    Zip: 

Daytime Phone:    Evening Phone: 

Email Address: 

Item #

Description

Quantity

Price
101 Teal & Orange Shag Rug 25.00
102 Yellow Solid Shag Rug 25.00
103 Light Blue Solid Shag Rug 25.00
104 Red & Cream Shag Rug 25.00
105 Navy, Green & Black Shag Rug 25.00
106 Olive Green, Orange & Burgundy Shag Rug 25.00
107 Green & Multi Color Shag Rug 25.00
108 Light Blue & White Shag Rug 25.00
109 Mint Green, Yellow & Red Shag Rug 25.00
110 Sea Blue, Green & Cream Shag Rug 25.00
111 Sunset Orange & Cream Shag Rug 25.00
112 Deep Red/Burgundy 25.00
113 Tan Rag Rug 25.00
114 Brown & Cream Rag Rug 25.00
115 Burgundy Rag Rug - Stripe 25.00
116 Burgundy & Deep Blue Rag Rug - Plaid 25.00
Total Items to Purchase

Amount Enclosed