order by fax

Please print this order form and fill it out. Please fax your order to Our American Heritage at (610) 695-0980 - Fax Available 24 hrs - 7 days

The Heritage Shop at St. Albans 3549 Rhoads Ave Newtown Square, PA 19073

Note: We DO NOT Ship outside the Continental United States - If you have someone that can trans-ship that is in the US we will do that for you

Your billing information:

First Name

Last Name

Street Address

City

State:
Zip Code:
Day Time Phone #

Evening Phone #

E-mail Address

For FedEx tracking information purpose only. Please provide your correct email address. Confirmation will be sent to you - Please remember to allow emails from FedEx.com is you use a Spam blocker

Credit Card
Visa Master Card Discover Card
Cardholder Name

Card Number

Expiration Date

CCV Number*
Required
Your Signature

* CCV Number - On the reverse side of Visa, Discover and MasterCard's on the Signature line to the right, a 3 digit number after the last 4 numbers of your account #, Amex 4 Digits on Front Lower right

Your ordering information: Need More Room ? Please just use a second blank page to write additional items

ITEM QTY AMOUNT

TOTAL

Your shipping address if it is different from your billing address: Sorry NO PO Boxes - Must ship to Street Addresses ONLY

First Name
Last Name
Company
Street Address
City State
Receiptant Phone Zip
Gift ? Gift Box ? Card ? Gift Bag ?
Message

Thank you for your order.

First Name
Last Name
Street Address
City			State:	Zip Code:
Day Time Phone #		Evening Phone #
E-mail Address	For FedEx tracking information purpose only. Please provide your correct email address. Confirmation will be sent to you - Please remember to allow emails from FedEx.com is you use a Spam blocker

Credit Card	Visa Master Card Discover Card
Cardholder Name
Card Number
Expiration Date
CCV Number*	Required
Your Signature

First Name
Last Name
Company
Street Address
City		State
Receiptant Phone		Zip
Gift ?	Gift Box ? Card ? Gift Bag ?
Message