Print this form, fill it out, mail it with your payment, made payable to: Blackford Distributors

Anniversary Weddinggifts.com.
Blackford Distributors
P.O.Box 569
Chocowinity, NC 27817
Office: 1-252-619-3687

Name:___________________________ Phone (required):___________________

Address:______________________________________Apt#________

City:________________________State:____________Zip:__________

Method of Payment: (Please no cash) Money order, Check, Credit Card

If by Credit Card: c/c#_______________________________________

Type: Visa, MasterCard, American Express, Discover (circle one)

Expiration Date:____/____

If by check: Driver's license #________________ State ____ D.O.B.___/___/___

Daytime Phone Number (required) _______________________

Product:

_________________________________________________

Quantity ______ x Price $______ = Subtotal: ______

Orders will ship by US First Class Mail. Shipping and handling rates are $7.95 and up based on gift chosen. All products are sent out by Priority Mail.There is an additional shipping charge for International orders. Please select the proper Country option when placing your order.
Handling Fee $____ x___ea: ______

Total: ______

THANK YOU!