CONTACT INFO:

E-Mail Address:  ________________________________

Name:  ________________________________________

Address:  ______________________________________

City:  ___________________ State: ____  

ZIP:   _____________

Phone:  (      ) ___  - __________    

Business Phone:  (       ) ____  -___________

Referred By:_________________________

*Shipping Charges
1-2 yarmalkes $1.50
3-4 yarmalkes $2.00
5-6 yarmalkes $2.50
Weddings and Bar Mitzvahs yarmalkes 
flat $9.95

kippon velcro holders 
$2.00 per pack plus
$0.34 shipping charges
(Free shipping if ordered with a yarmalke)

Full Payment Required with your order.
Make check or money order payable to:   
Mazel Tops Yarmalkes

Mail completed form with check/money order to:
Mazel Tops Yarmalkes
P.O. Box 69355
Los Angeles, CA  90069

Any questions, please 
email us or call 
Toll Free Telephone:  
(800) 397-0703

Price 
(Quantity x Price)

kippon velcro holder
($2.00 per pack)

Kippot - Weddings/Bar Mitzvahs 
add $10.00 imprinting setup charge for orders less than 5 dozen

Shipping and Handling 
(see above)

California Residents Only Tax Rate 8.25%(Calculate on total amount)

Total Order:                                 $_________________