Village Home Goods Fax / Mail-in Order Form
Enter the date:
Please enter credit card billing address:
Name on Credit Card
Street address
City
State/Province
Zip/Postal code
Country
Telephone
FAX
E-mail
Shipping Address if different:
First and Last name
Street address
City
State/Province
Zip/Postal code
Country
Credit card #:
Expiration Date #:
Select Type:
Visa
Master Card
Amex
Discover
Check/Money Order
Please provide the following product information:
ID #
Product Description/Model Each Total
Sub Total:
NY Sales Tax
Total:
Special Instructions:
Village Home Goods, Inc.
67 Jobs Lane
Southampton, New York 11968
Toll Free: 1-800-964-8227
Telephone: 631-283-4310
Fax #: 631-283-4701
Fax or Mail: Print out Form.
Page: © villagehomegoods.com