If
you wish to order goods via fax or mail method:
Print completed order form and Fax to Irishvictorian
at (+ 1-516) 785 3225
or
Mail to: Irish Victorian Gift Store, The Olde Towne
Garden, 1902 Wantagh Ave, NY11793
*Please use
the item numbers as shown on our web pages.
*Item No.
Quantity
Description
Size
(if any)
Price each
US$
TOTAL
US$
Total
US$
*Add
State Tax
Order
Total US$
*only
applies to New York and New Jersey customers
Name and address details
(*Fields
marked red are required to continue)
*Name
*Billing
address
*State/Country
*ZIP/Post
code
*Telephone
Fax
Email address
Ship
to
(if
different from above address)
*Payment
details: Credit Card Information*
*If you prefer, we will
contact you for your credit card details.
Visa
Mastercard
American Express
Discover
Card number:
Cardholder:
Expiry date:
If you should experience
any problems in faxing your order, contact
us immediately.