| Name | |
| Mailing Address | |
| City, State/Province | |
| Zip or Postal Code | |
| Name (s) of Lighthouses | |
| Total for Patterns or Kits (Please specify if you want patterns or kits) |
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| Postage (less than four patterns/kits is the cost of postage for one; if ordering more than four patterns, double the shipping costs) |
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| Total for Order | |
| Please include your email address for confirmation |