Close Window

Chincoteague Chamber Mail 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. Add shipping & calculate total
 Mail to:

Chincoteague Chamber of Commerce
P.O. box 258
Chincoteague, VA 23336

Checks, Visa, Master Card Accepted
Item Format
(Circle)		 Quantity Price Subtotal
Video
Chincoteage - Virginia's Island Treasure		 DVD

VHS

   20.00
(VA tax included)		  
Shipping: 5.00 each  
Total   
Credit Card Information
____ Visa
____ Master Card
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