If ordering via Master Card or Visa, you may fax the form to 434-971-1750.
Or you may mail with payment to:
Deidre Burridge Dagner
462 Shannon Glen Drive
Louisa, VA 23093
434-960-8420
MAIL ORDER FORM
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SPECIFY MEDIA!! - Printed Book ($19.50), e-Book ($15.00), CD
($15.00) |
(ea.) |
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| Handling charge per order: (except for e-Books) | $5.50 |
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| Subtotal: | ||||
| Total Amount of this Order: | ||||
| Name: | Date: | ||
| Address: | |||
| City, State, Zip: | Phone: | ||
| E-Mail (Please print): | |||
| Credit card # : | 3 digit verification #: | ||
| Credit card type (MC / Visa): | Expiration date (mm/yy): | ||
STANDING LIST ORDER FORM
| Complete the remainder of this form to be placed on our STANDING ORDER LIST. You will automatically receive new volumes of these publications as they become available. |
| Please place me on your STANDING ORDER LIST. I would like to receive each new volume of the Revolutionary War Period Bible, Family and Marriage Records as they become available. I agree to pay the invoiced amount within 30 days of invoice date. Payment from Libraries are subject to your usual procedure. |
| Signature: | Date: |