Heekin Pewter
P.O. Box 75020
Ft Thomas, KY 41075
Please fill out this form completely so that we can accurately ship your request. Only one item # on each line. Make check or money order out to HEEKIN PEWTER. If paying by credit card, be sure to give the full number and expiration date. Credit cards are not billed until your order is shipped. If you have any questions concerning your order, please call at 1-859-442-9807
Thank you.
             Ordered by:                                                                              Ship to:
NAME ______________________        ___________________________________
ADDRESS _____________________
                  _____________________		        ___________________________________
       ___________________________________
PHONE     ______________________        ____________________________

 
ITEM
NUMBER
DESCRIPTION 
 QUANTITY PRICE EXTENDED
PRICE
         
         
         
         
         
         
         
         
         
 
 
Shipping Costs
SUBTOTAL        __________________
non-chess set orders = $4.50
SHIPPING     ________________
all smaller chess set orders=$6.50
SALES TAX _ 6%   ________________
Large chess set        =  $18.00
                   (Kentucky residents only)                                      . 
TOTAL   _______________
CREDIT CARD ORDERS $15.00 MINIMUM ($15 before Shipping cost is added!)
VISA ________ or MASTERCARD ______DISCOVER________
CARD NUMBER ________________________________ EXPIRES ________________

SIGNATURE of CARDHOLDER ____________________________________________