PRINT OUT THIS ORDER FORM
and fax to 845-254-4476, or call in toll free 1-800-325-2665, or mail to
PURPLE MOUNTAIN PRESS, LTD., PO Box 309, Fleischmanns, NY 12430-0309
or click here to e-mail your order.

Payment for orders shipped within New York State must include sales tax.
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Sold to:



Name ___________________________________________________________


Address ________________________________________________________


City ___________________________________________________________


State/Province ___________________________ZIP/PC________________




Ship to (if different):



Name ___________________________________________________________


Address ________________________________________________________


City ___________________________________________________________


State/Province ____________________________ZIP/PC_______________




 ___ Gift wrap. Gift message ___________________________________
============================================================================================== Qty/Title/Price
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
_____ . . _________________________________________________________ . . __________
Shipping in the US: $3.50 per order (via USPS Media Mail) . . . . . . . ___3.50___
Extra shipping for UPS $3.50. . . . . . . . . . . . . . . . . . . . . . __________
Extra shipping outside USA: inquire for surface or air rates. . . . . . __________
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Subtotal . __________
. . . . . . . . . . . . . . . . . . . . . . . . .Sales Tax (NYS res.) . __________
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL . __________

Method of payment: ___Check/money order ___ VISA ___ M/C ___ Amex ___ Discover

Acct. ______________________________________ Exp. Date _______
S.C.*_________

Signature ____________________________________________________

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