Order Form

53 Downing Road
Bangor, Maine 04401

Henderson’s Redware

(207) 942-9013
Fax: (207) 942-9044
Toll Free: 866-376-4475

Retail Order Form

Print this page from your web browser and fill it out; then mail, fax, or call in your order

PURCHASER:

BILLING ADDRESS:

TELEPHONE #:

E-Mail:

SHIPPING ADDRESS (if different):

Date of Order:

Please allow 1-3 weeks for delivery

Date Shipped:

Method of Payment	Check Enclosed	Mastercard	VISA	Expiration Date:	V-Code:
(Check One):

Credit Card Number:

Quantity	Item Number	Item Name and Description (size, style, decoration, etc.)	Unit Cost	Extended Cost
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$

	Unit Cost	Extended Cost
SUBTOTAL:	$	$
Shipping will be added at time of order	$	$
ME residents only: add 5.5% sales tax	$	$
TOTAL:	$	$