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:______________________________________
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!