ORDER  FORM

SOLD TO:

Name

Address

City

State

Zip

Daytime Telephone

Evening Telephone

Date          /          /

Item #

Name
Description

Candle(C) or
Electric(E)

Finish:
Pewter (P)
or
Dk Antique (DA)

Qty

Price
Each

UPS
Shipping

Total

Method of Payment:  ¨  Check          ¨  Mastercard           ¨ Visa

Subtotal

 Credit Card #

Sales Tax
PA Residents Only (6%)

 Expiration Date

Packing

Included

 Signature

TOTAL

Please send order form and payment to:

The Stone House, 28 E. Market St., Middleburg, PA 17842
Or Fax Form to: (570) 837-1475.
Please call for phone orders and/or questions: Toll Free: 1-800-923-2260.

UPS Shipping Charges

Shipping prices on chandeliers by quote, including downlights.
Sconces ship at $4.35 per sconce.