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!