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Future
Heirlooms 717-768-3380 |
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Ship
To: Check
One:______Residence______Business |
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First
Name: |
MI.: |
Last
Name: |
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Address
1: |
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Address
2: |
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City: |
State: |
Zip: |
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Phone:
(
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If
this is a gift, indicate message on card
in space below: |
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Checks
or Money Orders send with this form to: |
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Name
of Item: |
Qty: |
Unit
Price: |
Options: |
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Subtotal:
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UPS
Ground Residential units:
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*Tax:
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TOTAL:
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Please include
E-mail Address:______________________________________ .
* Connecticut
residents add 6% tax to subtotal amount.
