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HERITAGE STUDIO ORDER FORM

Please type onto the form, print the form, send form with payment to
Heritage Studio
12003 North Valley Pike
Broadway, VA 22815

Your privacy means a lot to us. We do not share this information with anyone.
NAME DATE
COMPANY
STREET
CITY STATE ZIP

TEL. #: TEL. #:
E-MAIL:

SHIPPING NAME & ADDRESS (If different from above)
NAME
STREET
CITY, STATE, ZIP

ITEM # DESCRIPTION PRICE
Insured Shipping
VA Residents Add 5.3% Sales Tax
TOTAL ENCLOSED

We accept checks and money orders.
Checks must clear before item is shipped.

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