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!