Gifts By Vic Order Form

To order, please fill out this order form and mail to us using the information below. Upon receipt and clearance of your check or money order items will be shipped.
Gifts By Vic
513 Main St.
Galena, Kansas 66739
Ph. 620-783-2657

Please know that we handle all of your information in strictest confidence to protect your privacy, just as any store or mail order catalogue should. Your information will not be sold or be provided to anyone.
Please be advised we cannot ship C.O.D. orders or orders without payment.

Please Provide the Following Order Information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

Item With Description	Color	Price Ea.	Quantity	Total
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				$
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			Sub-total
			Total

Customer Comments,
Special Instructions:

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