Mail Order Form
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Please print this page, fill it out, and mail it with your payment to: Poland Chamber, Inc. 7 Lake Parkway Webster, Massachusetts, 01570, USA If you send cash, we recommend that you disguise it by putting it inside a brochure or catalog.
Make checks or money orders payable to Poland Chamber, Inc. Once received, we'll notify you and ship your products within 2 days of when payment clears. |
| Please List The Product(s)& Price(s) |
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| Circle Payment Method | Cash - Check - Money Order |
| Full Name | _______________________________________ |
| Address | _______________________________________ |
| Street 1 | _______________________________________ |
| Street 2 | _______________________________________ |
| City | _______________________________________ |
| State Name | _______________________________________ |
| Zip Code | _______________________________________ |
| Country Name | _______________________________________ |
| _______________________________________ | |
| Phone Number (optional) | _______________________________________ |
| Special Instructions (optional) |
_______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ |
