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Method of Payment: We accept Master Card and Visa! Check ___ Money Order ___ Credit Card ___ Card #: _________________________ Exp. Date: _______________________ Signature:_______________________________ Ship To: Name:__________________________________ Address:________________________________ Telephone/Fax:___________________________ Email Address: __________________________ Ordered by (If Different Than Above): Name:__________________________________ Address:________________________________ Telephone/Fax:___________________________ Email Address: __________________________ Gift Card Message: Mary Contrary ~ Treasures To Warm The Heart 227-A South Elm Street ~ Greensboro, NC 27401 Phone: 336.272.5700 Email: mary@marycontrary.biz © Mary Contrary, 2009