Just print out this page, fill in the information, and mail or fax it in.

Brettuns Village
PO Box 772
Auburn, ME 04212
(207)782-7863
Toll-Free 1-877-LEATHAH
Fax (207)782-7448
Order Form

Name:                _______________________________________
Address:           _______________________________________
Address:           _______________________________________
City/State/Zip:  _______________________________________
Phone:              ____________________________________  E-mail:   _______________________________________
Item Number
Qty
Units
Description (color, item name, etc)
Price
Each
Total
Price
           
           
           
           
           
           
           
           
           
     
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:

Thanks!
Brettuns Village, Inc.