The Rookery Order Form - from Chincoteague Shopping
Instructions:
  1. Print out this form
  2. Fill in the information
  3. Determine the total cost of the items
  4. Virginia residents add  4.5 % sales tax
  5. Add shipping & calculate total
 Mail to:

The Rookery Gift Shop
7058 Maddox Blvd.
Chincoteague Island, Virginia 23336

Checks and Major Credit Cards Accepted
Item Quantity Price Subtotal
One Horse Town Print   24.00  
Virginia Sales Tax - Virginia Residents Only (4.5 percent of subtotal)  
Shipping - $3.00 3.00
Total  
Credit Card Information
____ Visa
____ Master Card
____ American Express
____ Discover
Name as it appears on the card ____________________________

Credit Card Number ____________________________________

Expiration Date (Month/Year) ________________

Signature _________________________________

Billing & Mailing Address

Name

Apt. Number

Street Address

City

State & Zip

Telephone

Email