pre-printing the order form

Lisa M. Tolles*
The Scarlet Scarab – Temptations & Delights of the Past
Fine & Quality Accoutrements for the 18th Century Re-enactors / Historical Film Prop Supply
PO Box 122, Changewater, NJ 07831 (USA) • [email protected] • Fax #: 1-908-213-3285
From:
Date:
(your name)
Street:
PO Number:
City, State, Zip:
Phone/Email:
Qty.
Description of Item (color, size)
Visa
MasterCard
Unit Price
Price/Balance
SS/CV code
Copy account number from your charge card. All information just above on this form must be completed.
Expiration Date
Signature
CALCULATED POSTAGE/SHIPPING
Contact Us for the Correct Postage or UPS shipping
TOTAL
*Make checks or money orders payable to: Lisa M. Tolles
Kindly mail a copy of this purhase order with payment.
Post or via Courier to: The Scarlet Scarab, c/o Lisa M. Tolles, PO Box 122, Changewater, NJ 07831