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	Free
$55	$55
$100

Type of Payment

Check____________

Cash_____________

Credit Card__________   Number_____________________________   Exp. Date __________


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

The Daily Item C/O Nancy Zerbe 200 Market Street Sunbury, PA 17801