Joanna Gamble of Virginia

Boutique and Gift Shop

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500-18 Bulkeley Pl.

Newport News, Va.23601

               Name

                   Name

            Address

                Address

    City,State,Zip

        City,State,Zip

              E-Mail

                   E-Mail

           Phone #

                Phone #

                 Fax

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Bill to:

Ship to:

Item #

Description

Color,Size,Etc.

Qty

Price

Extended

Make Checks out to:

Joanna Gamble of Virginia

PLEASE CHECK ONE

SUBTOTAL

      Plus Shipping and Handling

                             Total

                          .............Card Number..................         Expiration Date

Personal checks will have to clear before order is sent ALL CREDIT CARDS WILL BE VERIFIED WITH THE BANK FOR SECURITY REASONS BEFORE SHIPMENT IS MADE .

For your security, and for credit card fraud prevention, we require the V-Code on your credit card.  This number is separate from your regular card number and only appears on your card. Flip your card over, you will see your 16 digit card number followed by another 3 digits.   This is your V Code.

Credit Card V-Code

__________________________________________________

Signature of Card Holder.  Must match  Bill  To Address

I authorize Joanna Gamble of Virginia  Boutique and Gift shop to charge the credit card number indicated above for the total above.

I certify theat the credit card number and signature above agree to the "Bill To" name above and that,as such, I am an authorized signer of this card.

ORDER:

  Shipping Charges:

  If your order is:

up to $24.99............................$  9.50

from $25.00 to $49.99.............$17.00

$50.00 to 100.00.....................$25.00

$100 and up.............................FREE

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Phone:   757-591-7696

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ORDER

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