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The American Flag Store Order Form
(PRINT FORM,
COMPLETE, THEN SUBMIT VIA MAIL OR FAX. PLEASE WRITE LEGIBLY.)
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Bill
To:
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Name:
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Company
(if applicable):
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Address:
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City/State/Zip:
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Daytime
Phone:
Email Address:
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Ship
To:
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Name:
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Company
(if applicable):
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Address:
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City/State/Zip:
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Daytime
Phone:
Email Address:
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Quantity
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Product
Description
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Price
Each
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Total
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*U.S. Shipping/Handling Charges: $7.99 for first item
and $3.99 for each additional item.
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Subtotal
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Flagpoles typically require additional
freight charges. Call 1-800-688-3709 for a freight quote.
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Shipping/Handling*
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Total
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Payment method:
[ ] Check or Money Order made payable to The American Flag Store and mailed to 140 West Street, Lisbon, NH 03585.
[ ] Credit Card: [ ] Visa [ ]
MasterCard [ ] American Express [ ] Discover
Cardholders Name:________________________________________
Card #: _________________________________________________ (Please
double-check)
Card Verification #: ________ (On back
of card. Amex on front.)
Expiration Date: Month __ __ Year __
__ __ __
[ ] Purchase Order: PO#__________________
(must fax copy and mail original)
Required for all orders:
Signature:____________________________________
Date:_____________________
Mail completed order form and payment to:
The American Flag Store
140 West Street Lisbon, NH 03585
or fax to: 603-838-6455
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