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

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If you, however, need to make your purchases 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.


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]

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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                      TOTAL  $_____________

          (made payable to The Peyton Society of Virginia)


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

​

_________________________________________________________________


_________________________________________________________________


_________________________________________________________________

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Purchaser Email address:______________________________________


Purchaser Phone#________________________



Thank you for your Purchases!