Chat Shoppe Mail Order Form

The Chat Shoppe Printable Mail Order Form The Official Site Of Bujno Pottery & Your Home For Personalized Gifts, Slate, & Home Decor Print Out Form - Print Information Clearly Below - Shipping To Continental U.S. Only MAIL & PAY TO: The Chat Shoppe, 510 Mingle Inn Road, Berwick, PA 18603

CHOOSE PAYMENT METHOD: ( ) Credit Card, ( ) Check, ( ) Money Order
Card Type: ( )Visa ( )Master Card	If Check - Enter Check #:
Card Number:	Make checks payable to: The Chat Shoppe
Expiration Date:	Make money orders payable: The Chat Shoppe

BILLING INFORMATION	SHIP TO (Leave blank if same as billing)
First Name:	First Name:
Last Name:	Last Name:
Address: (If RR#, list street name-No PO Boxes)	Address: (If RR#, list street name-No PO Boxes)
Address #2:	Address #2:
City:	City:
State:	State:
Zip Code:	Zip Code:
Home Phone: ( ) -	Home Phone (optional):
Email Address: (needed for order confirmation)

Merchandise Total:
PA Residents Only - Add 6% Sales Tax:
If Order Is $49.99 or Under - Add $5.00 Shipping:
Free Shipping For Orders $50 or More = 0:
TOTAL AMOUNT OF ORDER:
MAIL & PAYABLE TO: THE CHAT SHOPPE 510 MINGLE INN ROAD BERWICK, PA 18603 Toll Free: 1.877.752.2428

PRODUCTS TO ORDER (use additional sheet if needed)
Qty	Item #	Description	Unit Price	Ttl Price