ORDER FORM

Date

Name:

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Check enclosed for: $

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(Filling out this form does not automatically create an order. Use it for manually entering data only. You may print out this reservation form and mail it to us or fax it to: 804-739-2276.)
ITEM DESCRIPTIONUnit PriceQuantityShipping and
Handling
VA Residents add
4.5% sales tax
TOTAL
Clara Barton Doll $145.00 $10.00

PRINT OUT AND FAX THIS ORDER FORM TO
(866) 677-6894 (toll free)
Or Call (804) 245-1198

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