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:
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]
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)
Name and address (city/state/zip) where product is to be sent:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Purchaser Email address:______________________________________
Purchaser Phone#________________________
Thank you for your Purchases!
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:
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]
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)
Name and address (city/state/zip) where product is to be sent:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Purchaser Email address:______________________________________
Purchaser Phone#________________________
Thank you for your Purchases!
