: HERITAGE STUDIO :
ORDER FORM
mailing address:
12003 North Valley Pike Broadway, VA 22815

Please type onto the form, print the form, send form with payment to Heritage Studio.

NAME: DATE:

COMPANY:

STREET:

CITY: STATE: ZIP:

MAIL TO: (If different than above)...



TEL. #:

E-MAIL:

ITEM # DESCRIPTION PRICE
VA residents add 5% sales tax
Sub-Total
Shipping Costs see antiques or costume policy page
TOTAL ENCLOSED



Thank you, we appreciate your business!