Order form

Just print out this page, fill in the information, and mail or fax it in.
If you're asking us to ship to an address in Maine please add 5.5% sales tax, which the Governor will put to good use on your behalf.
PLEASE DON'T staple or tape your check to this page!

Brettuns Village
557 Lincoln St
Lewiston, ME 04240
Fax (207)782-7448

Name:                ______________________________________
Address:           _______________________________________
Address:           _______________________________________
City/State/Zip: _______________________________________
Phone:              ____________________________________       E-mail:   _______________________________________

Item Number	Qty	Units	Description (color, item name, etc)	Price Each	Total Price








			Maine addresses must add 5.5% sales tax
			Shipping and Handling	Included in most prices	$0.00
			Total Due

Notes:

Payment:   _____ Check Enclosed           _____ Charge my plastic (Visa, MC, Amex, Discover):
Card Number:       ___________________________________________________________
Expiration Date:    _____________________     Security Code: ____________________ (this is a 3-digit code on the back of most cards - for Amex it's 4 digits on the front)
If Card Billing Address is different from Shipping Address please provide the billing address here:

Minimum Order size is $5.00!
Thanks!
Brettuns Village, Inc.
PLEASE DON'T staple or tape your check to this page!