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