Download The LCA HS MUM Order Form

LCA- MUM
Order #: ______________________
(Official Use Only)
www.MelissasMums.com
Date: ________/_________/_________
Name: ________________________ Dates Name: _____________________ This Mum Will Be Worn By A: Freshman Soph.
Junior Senior
Email: ______________________________@_______________.______ Phone Number: (_____) ________-__________
Mum Base: Homecoming Ribbon: Name Ribbon: Sticker (For In Between Names):
Single Mum ($21.75) Extravagant Loops ($9.50) Extravagant Loops ($9.50) & Grad Cap Blank
Double Mum ($29.75) Extravagant Flat ($4.50) Extravagant Flat ($4.50)
Triple Mum ($35.75) Deluxe Flat ($3.25) Deluxe Flat ($3.25)
How To Wear Mum
Acetate Ribbon Boa ($4) Satin Ribbon ($1) Lanyard ($1.25)
Bear Decorations:
Tux + Top Hat ($4.75) Jersey + #____ ($3.25)
Flower Decorations:
Lighted Flower (w/ batteries) ($17)
Dress + Hair Bow ($4.75) Baseball Bear ($3.25)
Homecoming Arch ($1)
Mini Mum ($2) Eagle Head** ($4)
3 Glittery Stars ($1.50)
Grad Cap + Diploma ($3.25) Add’l 5” Bear ($3)
3 Glittery Hearts ($1.50)
Pom Poms ($1) Large 8” Bear** ($6)
Wire Garland In Mum ($2.75)
Glitter Hat ($2) Remove Bear (-$1)
Glitter Spray ($4)
Football ($0.75)
Flower Color: _________________
Rhinestones (10) ($1.75) Total For Section B:
Flowers* ($1.50)
**Will Replace Included Bear(s)
Rhinestones (10) ($2.75) $__________
__________________________________________________________________________________________
$0.50 Charms:
#1 Heart
3D Met. Football (1")
Soccer Ball
Baseball
Basketball
"Senior" Star
Class Star (3")
Glitter Star
Smiley Face
Peace Sign
Flower
Grad Cap
Diploma
Flat "HC" Football
Baseball Glove
"Grand Slam"
Bat + Baseball
Glitter Cross
Golf Ball + Tee
Baseball Cap
Golf Shoe
Jersey
Music Notes (2)
Band + Notes
Cleat + Soccer Ball
"Kick"
#1
$0.60 Charms:
"Offense"
"Defense"
3D Glitter Star
3D Baseball Glove
Homerun Diamond
"All Star" Flag
3D Heart (1")
Golf Bag
Flat Golf Club
Tennis Medallion
Academic Medallion
Wrestling Medallion
Domed Volleyball
Shooting Class Star
"Fight" Helmet
Cartoon FB Player
3D Met. Megaphone (1")
Flat Football Helmet
"I Love Music"
"Feel The Rhythm"
3D "Go Team"
Megaphone (1”)
"We've Got The Beat"
“Rock On”
$0.75 Charms:
"Senior"
"Seniors Rock"
"Seniors Rule" Flag
4” Class Star
3D Glitter Football (1")
3D Met. Football (2")
"Go Fight Win"
3D Golf Ball
3D Basketball
3D Soccer Ball
3D Baseball
Band
Track Shoe
Holographic Star (3")
1” 3D Glitter Helmet
3D 2-Tone Football (2")
“Star Player”
$0.90 Charms:
"We've Got The Spirit"
3D Heart (2")
"Class Of" ________
Rhinestone Star
Kissing Couple
Cross (3")
Math Hologram
Honor Roll Hologram
Science Hologram
3D Volleyball
I Heart My Team
Homecoming Fireworks
Eagle
Total For Section A:
$__________
Premium Charms:
Treat Bag ($4.25)
Teddy Bear (2") ($2)
3D Tennis Ball ($1.75)
Glitter Megaphone ($1)
3D Instrument ($1)
Hanging Love ($1.75)
Baseball Bat ($1.25)
Golf Club ($1.25)
Hockey Stick ($1.25)
Tennis Racket ($1.25)
Small Disco Ball ($1.60)
Med. Disco Ball ($2.50)
Large Disco Ball ($3.25)
"Awesome" ($1.25)
3D Football Player ($1.25)
3D Cheerleader ($1.25)
Homecoming + Yr ($1.25)
Total $.50 Charms:
$__________
Total $.60 Charms:
$__________
Total $.75 Charms:
$__________
Total $.90 Charms:
$__________
Total Prem. Charms:
$__________

Category “A” Ribbons:
($1.25/ea)
A1 A2 A3 A4 A5 A6 A7 A8 A9
A10 A11 A12 A13
Category “B” Ribbons:
($1.10/ea)
B1 B2 B3 B4 B5 B6 B7 B8
Category “C” Ribbons:
($0.90/ea)
C1 C2 C3 C4 C5 C6 C7 C8 C9
Plastic Garlands:
($1.85/ea)
Rhinestone Chain “Senior + Yr”
Hearts
3D Stars
Diamond Beads Volleyball
Mini Footballs Cheerleaders
Beads*
“HC” Stars
Chain Link Basketball
Stars
Baseball
Musical
*Bead Color:___________
*Bead Color:___________
Special Comments/Instructions:
Wire Garlands:
($1.50/ea)
Hearts
Stars
Music Notes
Grad Cap
Total for Section C:
$__________
Braids and Boas:
2 Big Feather Boas ($9.50) 2 Diamond Braids ($7.00)
Military Braid ($4.75) Spirit Braid ($3.00)
2 Military Braids ($8.25) 2 Spirit Braids ($5.25)
Diamond Braid ($3.75) 2 Boa Strands ($7.50)
Boa Color: Red Orange Yellow Hunter Lime
(Circle 1) Navy Royal Purple White Black
Hot Pink
+($2) White/Silver White/Gold Hot Pink/Silver
Purple/Silver
Bow Options:
Holographic ($1.25/ea): ____
Boa Big Color: Acetate ________________
($1/ea): ____
White/Gold ($.75/ea): ____
Hunter ($.75/ea): ____
Gold ($.90/ea): ____
Total for Section D:
$__________
(write a quantity)
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Bell/Whistle Options:
5”Cowbell ($6.50)
2” Cowbell ($2)
1.5” Cowbell ($1.50)
1” Hunter Cowbell ($1.50)
1” Cowbell ($1) u
Whistle ($1.25) s
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Band Whistle ($2.75)
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CIRCLE ONE
Cash Check Credit Card ($2) Card Type:_______________ Check/CC # __________________________________
Please fill in following if using Credit Card: Section A: $ _____.____ Section C: $______._____
Section B: $ _____.____ Section D: $______._____
Billing Zip code: _______________ $.50 Chrm: $ _____.____
CVV Number: _______________ $.60 Chrm: $_____.____ $10 Rush Fee Begins on Oct. 11 th
Name On Card: _______________ $.75 Chrm: $_____.____ Subtotal: $______._____
Expiration Date: ____/____/_____ , $.90 Chrm: $_____.____ Tax (8.25%): $______._____
Prem Chrm: $_____.____ Total: $______._____