Avalon Moon, Inc. Mail-in Order Form
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Ordered By  Please print clearly.

Ship To
When paying by credit card, name & address in 'Ordered by' must match credit card billing information.
Name: Name:
Address: Address:
Address: Address:
City:               City:             
State: Zip: State: Zip:
Phone #: E-mail:
Please include your phone # &/or e-mail address in case there is a question with your order.  All your information is kept confidential.
Item # Description

Price ea.

Quantity

 Total $
         
         
         
         
         
         
         
         

Sub-total

  

Less Discount

  

 Shipping*

  

NY State residents add sales tax

  

Total

  
Cash should be wrapped securely in paper or bubble wrap.
Paid by: __Cash __Check __Money Order
__Visa    __MasterCard    __American Express Card #:                     
Card exp. date:                             Card Code:
I agree to pay the above total amount according to card issuer agreement. Signature:

Comments:

Mail this form with payment to: Avalon Moon Inc., 68 Main Street, Delhi NY 13753-1121, USA

Thank you! 

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