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 Our American Heritage Shop  3553 West Chester Pike, #153   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

If you have any questions, please feel free to call us at (866) 884-3299.  Thank you for shopping at Our American Heritage Stores Div of PCG, Inc.  Copyright 2002-2014