Order Form

The Museum Store

Rome Area History Museum

ORDER FORM

BILL TO:	SHIP TO:
________________________________________ Name	_________________________________________ Name
________________________________________ Address Line 1	________________________________________ Address Line 1
________________________________________ Address Line 2	________________________________________ Address Line 2
________________________________________ City/State/Zip	_________________________________________ City/State/Zip
________________________________________ Daytime Phone Number	We can only ship to street addresses in the continental United States. Please allow 2-4 weeks for delivery.

PAYMENT METHOD: □ Mastercard □ Visa □ Cashier's Check □ Money Order

_______________________________________ Name as it appears on Credit Card	_________________________________________ Signature
_______________________________________ Credit Card Account Number	_________________________________________ Expiration Date

Please call 706-292-9977 with questions. Fax orders to 706-235-6631.

Total Cost: ________________

Sales Tax (GA residents only) X .07

TOTAL DUE: ________________