ERVK Order Form

Please print this order form fill in the information, and send it with your payment to:

ERVK, PO Box 255, Hyde Park, New York 12538

Name___________________________________________________________

Address:________________________________________ Apt:_____________

City:____________________________ State:__________ Zip:______________

Daytime phone:(___)____________________ E: Mail:_____________________

Ship to: (if different from above) (UPS will not deliver to a P.O. Box)

Name___________________________________________________________

Address:________________________________________ Apt:_____________

City:____________________________ State:__________ Zip:______________

ERVK does not accept C.O.D. deliveries.

Please make checks payable to: ERVK

If paying by credit card, please fill out order form below:
Credit Card No.:_________________________________________
Expiration Date:_______________________
Enclosed is my charitable contribution in the amount of: $______________
Item
Price
Quantity
Total
       
       
       
       
       
       
       
Subtotal:
     
Shipping/Handling:
     
Sales Tax (NYS add 7.25%):
     
Total: