Delta Zeta Memory Pillow and Ribbon Belt Order Form
To order, phone 800 947-2850 or print this form and fax it to (610) 935-1216,
or fill out and click "Send Order".
Name:
Ship To:
Phone: Email:
Kilarney Rose Memory Pillow Qty: @ $14.99
Forest Green Memory Pillow Qty @ $14.99
Pink DZ Ribbon Belt Qty @ $14.99
UPS Ground shipping charges will be added to order.
Visa or Mastercard #
Expiration Date
Billing address on card (if different from ship to address)