PEYTON SOCIETY STORE ORDER FORM FOR PAYMENT BY CHECK OR MONEY ORDER

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If you, however, need to make your purchases or donations by check:

Please print this section and mail it with your check/money order made payable to The Peyton Society of Virginia to Store Manager:

Ms Julia E. Moore

1190 Partridge Lane

Charlottesville, VA 22901  

Please note that this order form should not be used for payment of Membership applications or fees.

  • FOR FEDERAL TAX PURPOSES, ALL PURCHASERS OR DONATORS MUST INDICATE EITHER THAT THEY ARE A MEMBER OF THE PEYTON SOCIETY OF VIRGINIA OR THAT THEY ARE NOT A MEMBER OF THE PEYTON SOCIETY OF VIRGINIA IN THE FIELD BELOW, DURING THE ORDER OR DONATION PROCESS. PRODUCTS WILL NOT SHIP WITHOUT THIS INFORMATION.

​Name of first Product ordered _____________________

​# of this Product(s) ordered_____x Price $_______=first Product total      $_____________


Peyton ties (only) second Product

# of this Product(s) ordered (a)_____x Price $_______=second Product total $_____________

ties ordered in Blue #_______, in Wine #_______= total # ties ordered_____    [must equal total # ties ordered in (a) above]

​

Name of third Product ordered ____________________

# of this Product(s) ordered_____x Price $_______=third Product total     $_____________


Name of fourth Product ordered ___________________

# of this Product(s) ordered_____x Price $_______=fourth Product total    $_____________


Name of fifth Product ordered _____________________

# of this Product(s) ordered_____x Price $_______=fifth Product total      $_____________


ALL Product totals (first-fifth) ordered above            SUBTOTAL  $_____________

Add  $35.00 USD equivalent for International orders                 $_____________


Check/Money Order enclosed       GRAND TOTAL  $_____________

(made payable to The Peyton Society of Virginia)

Name and address (city/state/zip) where product is to be sent:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Purchaser/Donor Email address:______________________________________

Purchaser/Donor Phone#________________________

We must have the following information for federal tax purposes:

"X" IF Peyton Society of Virginia Member?______ Membership number, if known_____

"X" IF NOT a Member? ______


Thank you for your Purchases/Donation!