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The Roman Seniuk Order Form

Print and fill out this form to purchase Ukrainian Easter Eggs. Then send to with your payment [personal check or money order only-no credit cards] to: Roman Seniuk, 4451 Garvin, Detroit MI.48212.

NAME: ____________________________________________________

E-MAIL:____________________________________________________

STREET: __________________________________________________ 

CITY: ____________________ STATE____________ ZIP___________

[ ] This is a gift! Send it to:

RECIPIENT'S NAME: _____________________________

E-MAIL: ________________________________________

STREET: _______________________________________

CITY: ___________ STATE_____________ ZIP________

GIFT MESSAGE (s) ______________________________

I want to order the following Pysanky (e-mail us for out-of USA shipping charges):

    [  ] Chicken Eggs $35.00 or $40.00 [priority]

   [  ] GOOSE Eggs $65.00 or $70.00 [priority]

   [  ] OSTRICH Eggs $450.00 And Up

All Eggs are autographed. If you also wish your Egg to be inscribed, PRINT CLEARLY the name of the person to whom the inscription is to be made. Prices given are for the Eggs only. Add $10.00 for inscriptions or dedication (if any). E-Mail Roman Seniuk:  r_seniuk@hotmail.com
Note: Add $7.50 Per Order for shipping and Handling.  All Ostrich egg orders must be by E-mail.

Egg Total:  $__________

Total Amt Enclosed: $_________ [payment by personal check/money order only]

Mail form & Check to: Roman Seniuk, 4451 Garvin, Detroit MI. 48212