Order By Fax:
Fill Out This Form and fax to 1-610-584-1782, We will contact you with instructions on how to complete the transaction
Item Number: _____________________________________________________________________________________
Item Description: __________________________________________________________________________________
Price: ___________________________________________________________________________________________
Shipping Cost if Known: _____________________________________________________________________________
Total: ____________________________________________________________________________________________
Your name: _______________________________________________________________________________________
Address: _________________________________________________________________________________________
City, State and Postal Code: _______________________________________ Country: ___________________________
Phone Number: ________________________________ Fax Number: ________________________________________
Email Address: _____________________________________________________________________________________
Notes and Instructions: _______________________________________________________________________________
__________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Giamer Antiques and Collectibles