Please print and mail this form to
 

Ironweed Productions
PO BOX 144 
Almond NC 28702
828 488 4111

Ila Hatter`s Southern Appalachian Store
Mail Order Form Submission

1. Please enter the Items you are purchasing below

2. Please enter the shipping address.
Name:______________________________
Street Address:______________________________
City:______________________________
State/Province:______________________________
Zip/Postal Code:______________________________
Country:______________________________
Phone:______________________________
Shipping method:______________________________


3. Please enter the billing address.
Name:______________________________
Street Address:______________________________
City:______________________________
State/Province:______________________________
Zip/Postal Code:______________________________
Country:______________________________
Phone:______________________________


4. Please enter the paying method.
*If sending check (Allow 10 days to clear bank before order will be shipped)
Credit card type:______________________________
Credit card Number:______________________________
Credit card expired Month:______________________________
Credit card expired Year:______________________________

Signature _________________________________ Date________