Order Form

The Great 1870 Flannel Nightie Co.
R.R. 3
Mildmay, Ontario
Canada
N0G 2J0
Phone: 519 799-5405
Fax: 519 799-5400
E-mail: info@flannelnightie.com

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Customer Information

Bill To:	Ship To:	(Check if same as Bill To: )
Name:	Name:
Address 1:	Address 1:
Address 2:	Address 2:
City:	City:
Prov./State:	Prov./State:
Country:	Country:
Postal/Zip:	Postal/Zip:
Phone:	Phone:
Fax:	Fax:
Email:	Email:

Order Information

The Classic Collection
Style	Size	Colour	Wrist	Height	Quantity

Payment Information

Payment Method:

Please click on the Submit button to e-mail your order to The Great 1870 Flannel Nightie Co.
You will receive a confirmation of your order by e-mail within 24 hours.