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ORDER FORM

Date

Name:

Shipping Address:

City: State: Zipcode:

Phone Number: Fax Number:
E-Mail Address:

Check enclosed for: $

Charge to:VISA MasterCard American Express

Card number:
Expiration date:

(Filling out this form does not automatically create an order. Use it for manually entering data only. You may print out this reservation form and mail it to us or fax it to: 804-739-2276.)
ITEM DESCRIPTIONUnit PriceQuantityShipping and
Handling
VA Residents add
4.5% sales tax
TOTAL
Elvis Stained Glass Tableau $99.50 $5.00
"Reminiscences of Robert E. Lee" Book $145.00 $2.25
Sterling Silver Christmas Ornament $37.00 $3.00
Renoir Umbrella Dolls $1740.00 $12.00
Yeager Lithograph $180.00 $10.00
1999 Christmas Plate $135.00 $5.00
Art Glow Light $25.00 $5.00
Double Eagle Statue
Please attach name to be engraved
$2250.00 $50.00
Florence Nightingale
17" Doll
$135.00 $7.00

PRINT OUT AND FAX THIS ORDER FORM TO
(804) 739-2276
Or Call (804) 739-1198
Or Mail to: USHS -c/o Art Dept Inc.
14714 Midship Woods Ct.
Chesterfield, VA 23832
Make checks payable to The United States Historical Society

Free Examination Policy of the United States Historical Society.
You may examine any order for 30 days. If, for any reason, you decide not to keep it, you may return it for a full and unquestioned refund.

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