Order Form
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Full Name
______________________________________________________________ (required)
E-mail _________________________________________________________________ (required)
Address 1 ______________________________________________________ (required)
Address 2
______________________________________________________________ (if needed)
City._______________________________
State ___________ Zip ________________ (required)
Home Phone. ______________ Work
Phone _______________ Fax ______________ (required)
If paying by credit card, the above information MUST BE THE SAME as your credit card billing address. If you wish to have your material shipped to a different address, please so advise.
If paying
by check, please provide references: preferably a nationally known
dealer or auction house. If references are not nationally known,
please provide their contact information.
Reference
1: ______________________________
Reference
2: ______________________________
[ ] CSA membership
number _____________
[ ] APS membership
number _____________
[ ] USPCS membership number __________
[ ] Other,
membership number __________
Item number
___________ Brief description ______________________________________
Price _____________
Item number
___________ Brief description ______________________________________
Price _____________
Item number
___________ Brief description ______________________________________
Price _____________
Item number
___________ Brief description ______________________________________
Price _____________
Item number
___________ Brief description ______________________________________
Price _____________
Sub-total
_____________
Discount _____________ See Ordering
and Sales Policies
Shipping _____________ See Ordering
and Sales Policies
Total ________________.
[ ] I will
send check or money order in U.S. funds.
[ ] I prefer to pay by credit card (VISA, MasterCard, Discover). Address above must be the same as credit card billing address/phone.
 .......Credit Card holder's name__________________________________________________________
.......Credit Card number_______________________________________________________________
.......Expiration Date (required) ___________________________________________________
.......Security Code -- last three numbers printed on the signature strip on the back.(required) _______
[
]  I
prefer to pay with PayPal. Please email me an invoice.
[
] I have read, acknowledge and understand
the Terms and Conditions of sale: Ordering
and Sales Policies
All
orders will be acknowledged. If you don't get an acknowledgment
within 24 hours, I didn't receive the order for whatever reason.
If that happens, please call or try direct email. I usually post show dates on the retail page when I am unable to fulfill orders.
I
apologize that this is not an interactive order form, but my web
host server does not seem to be able to provide a form that works
100% of the time.
Remit orders
to:
Patricia A.
Kaufmann
10194 N. Old State Road
Lincoln, DE 19960
Phone: (302)
422-2656
Fax: (302) 424-1990
E-mail: trishkauf@comcast.net |
