Order Form for Check or Money Order Transactions:

Send this form along with payment to:

Waterford Past-Thymes
16039 Hamilton Station Road
Waterford, VA 20197

Customer Information:

NAME_______________________________________________
ADDRESS____________________________________________
CITY_______________________________________________
STATE______________________________________________
ZIP CODE___________________________________________
PHONE______________________________________________
FAX________________________________________________
E-MAIL_____________________________________________

Shipping Information: Use this area only if you 
would like us to ship to a different address.

NAME_______________________________________________
ADDRESS____________________________________________
CITY_______________________________________________
STATE______________________________________________
ZIP CODE___________________________________________

calligraphy text(optional):________________________

___________________________________________________

___________________________________________________

FRAME CHOICE:______________________________________

SIZE:______________________________________________

All of our prices include shipping and handling within
the continental U.S.

Canada:    $40.00
Elsewhere: $65.00

WEDDING PRESERVATION DEPOSIT         ______________

TOTAL PURCHASES:                     ______________
SHIPPING & HANDLING:                 ______________
TOTAL:                               ______________