ORDER FORM - The Valerie Peyton Horn Collection

The Valerie Peyton Horn Collection - ORDER FORM

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Oder Form - Word Document

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Mail or Fax this form to Valerie Peyton Horn.
All purchases payable by MasterCard, Visa or check made payable to:

Valerie Peyton Horn
20 Meeker Court
Rowayton, CT 06853
Phone: 203 866 9242
Fax: 203 899 0351

Name	Date
Street Address
City	State	Zip
Credit Card Type	Visa	MC
Credit Card Number
Expiration Date

QTY	ITEM NO.	ITEM NAME	UNIT PRICE	AMOUNT






			*SHIPPING
			TAX
			TOTAL

*For SHIPPING & HANDLING
add $5.00 to total dollar amount.
Please be advised of a 2-3 week delivery for all items.
All claims for damages must be made 10 days after receipt of merchandise, or no credits will be allowed