R.D.P. COUPON BOOK ORDER FORM 

Print this form, fill it out completely and mail it along with your check or money order for just $29.95 payable to
Shelley Pieper-Reynolds (R.O.S.E.). We’ll rush your coupon order book to you so you can cash in on your
very first shopping trip!

Shipping / Payment Information (Required)

First Name

Last Name

Address

City

State or Providence

Postal Code

Daytime Phone

Evening Phone

Method of Payment

Quantity

Total Cost

* Private information will not to be sold nor used for purposes other than for confirmation of this transaction.


Print out and mail this order form with your check or money order to:

Shelley Pieper-Reynolds (R.O.S.E.)
Coupon Book Processing Center
PO Box 32
Cottage Grove, MN 55016

Upon receipt of payment, your order will be shipped. 

Allow 1 – 2 weeks for delivery.

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