Mail Order
Ordered By


Name


Address Billing address, for credit card verification purposes.

City
State
Zip

MM 		/
DD 		/
YY

Shipping Options
2-Day UPS
Overnight UPS today
Overnight UPS
UPS Saturday
UPS Overnight Saturday 		2-Day FedX
Overnight FedX 3 pm
Priority Overnight 10:30 am
Saturday FedX
 Registered Mail  Express Mail
 
**Due to the value, we ask UPS to obtain a signature.
 Will there be someone at the provided address to sign for your purchase when it arrives?
Telephone Number 9 am - 5 pm Weekdays                                                  
Catalog # or
Style # 		Description Registry
Number 		Price
Total
Method of Payment                                                                                       

Check or money order enclosed (no C.O.D. please). Allow 2 extra weeks for delivery on check orders Charge my
MasterCard Card 		Charge my
VISA Card 		Charge my
American Express Card 		Charge my
Discover Card
      
Credit Card Number                                 from back of card
/            
Expiration Date                Please print name as it appears on credit card
Subtotal:
Maine Sales Tax:
Shipping is FREE!:
Total:
 

Special Instructions:

If sending items to the address below:

Receipts to go the above address
Receipts to go the address below
Is this being sent to the recipient
       If so, do you wish to have a card enclosed?  yes  no
        Please fill in the above "Special Instructions" area for card text

FUTURE CATALOGS:

  Above address

  Address below

Ship to Address or Gift Address    Is this a business?  yes  no  


Name to which package should be sent

Company Name


Address

City
State
Zip