Brettuns Village
557 Lincoln St
Lewiston, ME 04240
Fax (207)782-7448
Order Form
Name: ______________________________________
Address: _______________________________________
Address: _______________________________________
City/State/Zip: _______________________________________
Phone: ____________________________________ E-mail: _______________________________________
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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!