TO BE ANSWERED BY THE BRIDE AND GROOM:

Today's date: (Please allow for your calligraphers minimum time.)
Your Email Address:
Your Phone Number: (In case of an order question)
Contact Name: (In case of an order question)

The completed Ketubah is to be sent to: (Your address or Calligrapher's address)
Name:
Address:
City, State:
Zipcode:
Country:

Please check which Ketubah you wish to order:
Flowers of Paradise Evening of Roses Fragrant White Flowers

Please check which text style you want for your ketubah:
Traditional Aramaic (no English)
Traditional Aramaic/English
Egalitarian English/Egalitarian Hebrew
Interfaith
Conservative (Eve of Roses only - no English)
Conservative/Egalitarian English


Bride's Information:
Bride's English Name: (as wanted on the Ketubah)
Address:
City, State:
Zipcode:
Country:
Phone:

Please check these for the Bride:

Are you a Cohen?	Yes	No
Are you a Levy?	Yes	No
Are you Divorced?	Yes	No
Are you converted to Judiasm?	Yes	No
Are you Widowed?	Yes	No
Is this your first marriage?	Yes	No
Is your father alive?	Yes	No

Date of Wedding: Month: Day: Year: Time of Day:
Place of wedding: City: State:

We certify that the information contained on this form is correct.
Groom's Signature: Date:
Bride's Signature: Date:

Questions, comments, concerns:


The cost for a single Ketubah purchase is listed below. If ordering more than one, be sure to indicate this on your order and multiply the price accordingly.

Item	Cost Per Unit	Your Cost
Ketubah	$200.00
Shipping and Handling	$12.50
Rush Order (less than 2 weeks)	$25.00
Subtotal
Tax 4%
Order Total

Method of Payment: Visa Mastercard Check or Moneyorder
Credit Card Number:
Credit Card Expiration Date:
Name on Credit Card: