Please print this on your printer and mail to Stamp Affair at the address on upper left of form.

Stamp Affair
500 Park Avenue, Suite 207
Lake Villa, Illinois 60046
847-265-3330  fx 847-265-3331		 CUSTOMER  ORDER FORM
SOLD TO:
Leiko Nortman
6541 Doriane Circle
Huntington Beach, CA 92647
Phone: 714-596-0109
Email: chickypicky@socal.rr.com 
ID: 5687567LN
 SHIP TO:
NAME ________________________________
ADDRESS _____________________________
CITY,STATE,ZIP_________________________
______________________________________

YOUR EMAIL ADDRESS ____________________
TELEPHONE NUMBER _____________________

QUANTITY

 PART NUMBER

 PG.#

    DESCRIPTION

     EACH

 TOTAL
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
 

SUBTOTAL

    
 

SHIPPING & HANDLING:(MINIMUM $6.75 shipping)

 +10%  
 

ILINOIS RESIDENTS ADD

 6.75% Tax  
 

GRAND TOTAL

    
CREDIT CARD INFORMATION _VISA  _M/C  _DISCOVER  _AMEX
ACCT# ______________________________ EXP DATE _______________
NAME ON CARD _____________________ SIGNATURE: _________________________