New Helfta Atelier · PO Box 464 . Geneseo, NY 14454

Tel. 585-245-8612 · Fax 585-245-8613 · Email: minhkh@rochester.rr.com · Web site: www.ourladyofnewhelfta.com

Invoice

Invoice No.: _______________

(1^st, 2^nd or 3^rd )

Invoice Date: _______________

Patron/contact person: ______________________________________________________

Address: _____________________________________________________________________________________

City/State: ____________________________________________________ Zip code: ______________________

Phone: _____________________________________________ Fax: _____________________________________

Item # Type of Service/ Sale/ Comments Quantity Amount

1

2

3

4

5

Subtotal: __________

Tax: __________

( New York residents add your tax to the above Subtotal. Tax

Exempt organizations, please include certificate with order)

Shipping and handling: __________

Amount due: ________ Amount Paid: ___________ Amount remains: ________

Please make check payable to New Helfta Atelier

Due date: ________ Amount enclosed: _________

Signed: ________________________________________________ Date : ____________________

(Patron / contact person)

Print name: ______________________________________________________________________

Please sign, date and return one copy with payment. Thank you for your business.

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