This Order Form is Secured by Comodo
 Hers & Mine Antique, Inc.

Free Shipping on order $100 and up in USA Only [Insurance Extra] Limited Time

1.     Use Tab Key or your Mouse to move from Name to Address, etc.
Enter Key will send an incomplete order.

Please provide the following information to complete your Order
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail

                     Item Number, Description & Please include Price after description.

  QTY   Item  Number        Description of Item & Please include Price

Shipping is extra charge. Shipped by U.S. Postal Priority Mail or  UPS.  If you have a preference please lets us know by
email  Barbara@HersMine.com or call toll free 1-866-290-9606
 Free Shipping on order $100 and up in USA Only [Insurance Extra] Limited Time
Payment Information:

Credit Card  
Card Number
Exp. date & Last 3 No on Back of Card (Month/Year) --[last 3 number on back]
Amount plus shipping charges to be calculated
Name on Credit Card:
Billing address  only if different than shipping
Billing address & Zip Code
 
 



 

Back to Home Page