Amana Heritage Society Mail Order Form

Customer Information

Name_____________________________

Address_____________________________________________________________

City:______________________________

State:_________Zip:_______ - ________ Phone #___________________________

Credit Card Orders

circle one:     Visa      Master Card

Account #_______________________

expiration date ___/___/___

Signature ______________________________

Shipping & Handling

$5.00, for subtotals under $25.00

$7.00, for subtotals under $50.00

$8.00, for subtotals under $75.00

_____________Subtotal

_____________less 10% Discount
(Amana Heritage Society members only)

I want to become a member! Add to total due.
Patron ................... $100.00
Contributing ...............$35.00
Family .......................$20.00
Individual ...................$15.00

____________Shipping & Handling

_____________Total

Amana Heritage Society
PO Box 81
Amana, IA 52203
Phone and fax orders accepted for credit card sales. Please call (319) 622-3567 or fax this order form to (319) 622-6481.