Locust Grove

Locust Grove Museum Store
ORDER FORM

Phone (502) 897-9845/ Fax (502) 897-0103

Date: ________________

Please complete this form and mail or fax with check or credit card information to:

Locust Grove Museum Store
561 Blankenbaker Lane
Louisville, KY 40207
FAX: 502-897-0103

Item #	Quantity	Item Description	Item Price	Total Item Price










Shipping: 1 item - $6.00 2-5 items - $10.00 5-10 items $15.00 * The Kentucky sales tax of 6% is collected for all shipments within Kentucky. **All items shipped USPS unless UPS or FedEx requested at time of order. Additional shipping charges will be charged depending on method requested.			Subtotal
			subtract 10% discount for HLG members
			add 6% sales tax for KY residents*
			Shipping and handling **
			Total

Shipping Address: Credit Card: (Visa-Mastercard only)

__________________________________________ Visa MasterCard
Name Circle One

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Street Address#1 16 Digit Credit Card

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Street Address #2 Expiration date

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City, State, Zip-Code Billing Zip-Code

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Phone Number

Billing Address (if different from shipping):

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Name

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Street Address#1

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Street Address #2

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City, State, Zip-Code

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Phone Number