Newburgh Country Store
Newburgh, Indiana

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 Order Form


Telephone:
   Call us at 812-853-3071
Fax:
   Print out form and fax it to us at the Newburgh Country Store at 812-853-7707
Mail:
Print out form and mail it to us at the Newburgh Country Store at:

Newburgh Country Store
224 West Jennings Street
Newburgh, Indiana  47630 

Ordered by:

Your Name: 

Your Address: 

Your City:  Your State: 

Your Zip: 

Your Country: 

Your Daytime Telephone Number (with area code): 

Your Evening Telephone Number (with area code): 

Your Online or e-mail address: 

Deliver to: 
(If this is a gift purchase)

Recipient's Name:

Recipient's Address:

Recipient's City: Recipient's State:

Recipient's Zip Code:

Recipient's Phone Number:


Basket or Book Information:

Name:
Quantity: Price of Item: Subtotal:
Indiana Residents Add 6% Sales Tax to Your Order:                                        
Shipping and handling: ($12.95 for all baskets except 
Over the Counter Big Deal which is $15.95)
Write Your Total Here:                                                                                          



Arrival and Gift Instructions:

Preferred Arrival Date:    

Gift Card or Autograph Instructions:
 

Payment:

Please select from one of the following:

Visa
Master Card
American Express
Discover
Check
Money Order

Credit Card Signature:
Credit Card Number:
Expiration Date:

Note: Indiana Residents add 6% Sales Tax to Your Order Please allow 10 days for delivery. Shipping and handling charge is $6.95 (except Big Deal)  for each basket $3.95 for each book.  
 
©Copyright 2001 Newburgh Country Store, All Rights Reserved
Last Revised on February 22, 2001
 

Newburgh Country Store
Newburgh, Indiana
812-853-3071
Contact the webmaster at robklu021359@yahoo.com 
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