ORDER FORM

We appreciate your printing this page, filling it out, and then faxing it to us.
AntiqueLine voice/fax: 914-276-0666

List Item ID Number & Name of any items you want to purchase:

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Your name: ________________________________________________________________________

Address: ______________________________________________ Apartment or Suite: _________

City: _____________________________________ State: __________ Zip Code: _____________

Country: __________________________________________________________________________

Phone number (area code first): _______________________________________________________

Ship to if different than above: ________________________________________________________

Payment method (circle one):

Please provide number and expiration date: _____________________________________________________

We will call or fax you (whichever you wish), with date the item will be sent and shipping and handling charges.
Please note that credit card puchases will be sent out within 1 day (weekdays), we will accept personal checks
but they must clear before we send the item purchased.

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