Heroines Fax/Mail Order Form

Fax to:

763-450-5005

Mail to:

Heroines Orders
Orion Associates Offices
9400 Golden Valley Road
Golden Valley, MN 55427

HEROINES by Jila Nikpay

Paperback Edition - $22.00

Number of Sets:

Shipping/Handling:


per set
per set

Minnesota Sales Tax 7.0%:

($1.54 per set if applicable)

Order Total :

Billing Information
Shipping Information
(if different from Billing Information)
Name: Name:
Address: Address:
City, State, Zip:

City, State, Zip:

Email:
 
Phone:

Payment Method
Money Order

Credit Card Information

Card number
Card Expiration Date

Signature (required for Credit Card Orders):

_____________________________________

Personal Check
Mastercard
Visa
 
Notes or Special Instructions:

When finished, click the 'Print this Page' button to print this form.

 

Thank You For Your Order!