RETAIL ORDER FORM

PLEASE ALLOW TWO WEEKS FOR RETAIL ORDER PROCESSING.
PRINT THIS ORDER FORM AND MAIL WITH PAYMENT TO:

PENNSYLVANIA PRIMITIVES
1306 Cambria Avenue
Windber, PA
USA  15963
Email: info@pennsylvaniaprimitives.com

Circle Payment Method:             Money Order    VISA    MasterCard    Discover   

  Print Name:
  Address:   Email:
  City:   Credit Card #:
  State & Zip:   Expiration Date:
  Telephone:   Signature:

Item Name and Description

Quantity

Price
     
     
     
     
     
     
     
     
     
     
     
     
     
 
    

Subtotal:  

    

Add Shipping:
Actual UPS rates will apply. Please add shipping as calculated by our cart.
RETAIL ORDERS OVER $100 SHIP FREE! (CONT. USA ONLY)
  

    
 
    

MAKE MONEY ORDERS PAYABLE TO: PENNSYLVANIA PRIMITIVES  

Total :

 


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