Shipping Address:

Name: ________________________________________________________

Address:_______________________________________________________

City: ________________________________ State: ____________________

Country:______________________________ Zip Code: ________________

Telephone: (________)__________________

QTY DESCRIPTION PRICE EA. COST
       
       
       
       
       
       
       
       
       

Shipping & Handling:
$5 for orders under $20
$10 for orders $20 - $39
$15 for orders $40 - $99
$20 for orders over $100

Please send this completed form and a check or money order payable to Historic RittenhouseTown, Inc. to the following address:

Historic RittenhouseTown
206 Lincoln Drive
Philadelphia, PA 19144

SUBOTAL  
Members subtract 10%  
PA Residents Add 7% Sales Tax  
Shipping & Handling  
TOTAL