Unique Gifts & Hand-Painted Treasures
Order Form


DATE_________  PHONE _______________________               _____CHECK     _____MONEY ORDER

NAME________________________________________              _____VISA     _____MASTERCARD

BUSINESS____________________________________              NUMBER______/  ______/  ______/  ______

ADDRESS____________________________________               EXPIRATION DATE   ______/______

ADDRESS 2__________________________________                CSV CODE_____ (3 or 4 digits)

CITY_________________ STATE____ ZIP________                  EMAIL______________________________

 

Quantity

Item and Description

 Price Each

Total
       
       
       
       
       
       
       
       
       
       
       
       
       
       

SUB – TOTAL 

 

SALES TAX (FOR VIRGINIA RESIDENTS)  5%

 

TOTAL

  

SHIPPING / HANDLING

  

 

  

GRAND TOTAL

  

CLICK HERE for Printer-Friendly Order Form in PDF Format

FOR CREDIT CARD ORDERS

Complete This Order Form and Then FAX To – 757-824-0112

-OR-

Mail ORDERS To – GoldenWheat, Inc., PO Box 308, New Church, VA  23415

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PO Box 308
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