A Very Special Collection
PRINT AND MAIL FORM

Print out order blank, complete form, and mail to:

A Very Special Collection
PO Box 2243
Yorktown, VA 23692

Fax or phone in completed order to: 757-867-7711


Name: Date:
Address: Phone:
City & State: Zip:

Item# Name Quantity Item Price Extension

Shipping & handling:

$ .00 to $5.00 - $1.50
$5.01 to $10.00 - add $2.50
$10.01 to $30.00 - add $5.35
$30.01 to $50.00 - add $7.50
...... over $50.01 - add $10.00

Make checks payable to:
A Very Special Collection

For credit card payment:
Circle One:
Visa --- Master Card --- Discover

Account Number:

Expiration Date:

Signature:

         
         
         
         
         
         
  Sub Total  

Virginia residents add 5% sales tax.

Sales Tax  
See chart to determine correct shipping
Shipping  
All International orders, send e-mail for shipping rate Total Due  

THANK YOU!


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© Copyright 2010 A Very Special Collection, P.O. Box 2243, Yorktown, VA 23692. All rights reserved.