Weddings - Engagements - Anniversaries



Name                  ___________________________________

Address              ___________________________________

Email Address   ___________________________________

Phone Number   ___________________________________

           Circle your selection below

          Engagements         Anniversaries      Weddings


Circle the package(s) you want

Wedding/Engagements                Anniversaries

Free $140       Free
$55 $165       $85
$88 $200
$120


Type of Payment

Check____________

Cash_____________

Credit Card__________   Number_____________________________   Exp. Date __________


Checks should be made out to The Daily Item and with the form sent to:

The Daily Item
C/O Tricia Pursell
200 Market Street
Sunbury, PA 17801