Butterflies of Delmarva Order Form

Ms./Mrs./Mr.______________________________________________
Address__________________________________________
City ______________________________________ State _______ Zip _______
Daytime Phone ________________________________________
Email Address _________________________________________
(Note: Please include your email address if you would like to be added to our mailing list.
We will not share your email address with any other party.)

---

(Please note: Due to changing postage rates, we highly recommend charging your purchases)

Quantity

Price

Total

Butterflies of Delmarva

_______

$12.95

$_______

Merchandise Total

$_______

Less 10% Members Only Discount

$_______

Subtotal

$_______

MD Residents Add 5% Sales Tax

$_______

Shipping: 1 book = $5.00

$_______

(If ordering more than 1 item, items will be shipped at actual cost with credit card info)

Total Amount Due

$_______

Payment Type (Circle One)

Check/Money Order

Visa

Mastercard

Credit Card Number ________________________________
Exp. Date _______ (mm/yy)
CVV or CSV Number* __________
Signature ____________________________________________

(*CVV or CSV - VISA and MasterCard require the three-digit Card Verification Value (sometimes call Card Security Value) in addition to the card number. This number is typically found written on the right side of the signature line on the back of the card.)

Make checks and money orders payable to Friends of Blackwater

Mail order to Friends of Blackwater, Inc.
P.O. Box 1231, Cambridge, Maryland 21613

Or fax completed order form to 410-221-7738

Or call 410-901-6125 and leave a message to place an order. All calls will be returned.

For additional information, contact Peggy Tillier at eaglesnest16@hotmail.com
Thank you for your order!