Joanne Rothermal

CUSTOM ORDER FORM CUSTOM ORDER FORM Name: ______________________ Name: ______________________ Email: ________________________ Email: ________________________ Phone: _______________________ Phone: _______________________ ----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- Clock Name (if known): _____________________ Clock Name (if known): _____________________ Size:- other ______ Size:- other ______ Colours: Centre _____________ Colours: Centre _____________ Outer _______________ Outer _______________ Groove ______________ Groove ______________ Digits: Roman Numerals Numbers Digits: Roman Numerals Numbers Text (if required): _____________________________________________ Text (if required): _____________________________________________ Additional comments: _____________________________________________ Additional comments: _____________________________________________ ____________________________________$ _______ ____________________________________$ _______ Payment is due on completion. Marble Hill Clockworks will do their upmost to make your clock to the specifications outlined above. If you are not entirely satisfied, you are under no obligation. Payment is due on completion. Marble Hill Clockworks will do their upmost to make your clock to the specifications outlined above. If you are not entirely satisfied, you are under no obligation. CUSTOM ORDER FORM Name: ______________________ Email: ________________________ Phone: _______________________ ----------------------------------------------------------------------------------Clock Name (if known): _____________________ Size:- other ______ Colours: Centre _____________ Outer _______________ Groove ______________ Digits: Roman Numerals Numbers Text (if required): _____________________________________________ Additional comments: _____________________________________________ ____________________________________$ _______ Payment is due on completion. Marble Hill Clockworks will do their upmost to make your clock to the specifications outlined above. If you are not entirely satisfied, you are under no obligation. CUSTOM ORDER FORM Name: ______________________ Email: ________________________ Phone: _______________________ ----------------------------------------------------------------------------------Clock Name (if known): _____________________ Size:- other ______ Colours: Centre _____________ Outer _______________ Groove ______________ Digits: Roman Numerals Numbers Text (if required): _____________________________________________ Additional comments: _____________________________________________ ____________________________________$ _______ Payment is due on completion. Marble Hill Clockworks will do their upmost to make your clock to the specifications outlined above. If you are not entirely satisfied, you are under no obligation.