The Old Blue Barn FAX order Form

The Old Blue Barn FAX order Form FAX / Phone # 860.747.5205

Buyer's NAME:	E-mail address
Address:
City	State
Zip or Mail Code	Country	Phone Number

SHIP TO ABOVE ADDRESS SHIP TO Different ADDRESS Please gift wrap (complimentary)

SHIP TO: NAME
Address:
City	State
Zip or Mail Code	Country

Payment type Credit card - Select one Visa Master Card Discover AME

________________________Card Number ____________ Expiration Date ______Verification Code (3 numbers on back of card, or 4 numbers above card on American Express) _________________________Name on card
I will mail a Check or Money Order
I would like someone from The Old Blue Barn to phone me. Best time for us to call: _________am pm

Item #	Description	Quantity	Price	Total







FREE SHIPPING w/orders over $100 within the Continental USA *surcharges may apply on heavy or oversized items. Please see item description for cost.		USA Shipping		$7.50 under $100 CONTINENTAL USA
	Please call us for International Shipping Rates

Questions / Comments?