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