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Flint Brook Pottery

1904 West Hill Road ~ Roxbury, VT 05669
(802) 485-4209
Email: deb@flintbrookpottery.com

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To order by check, money order, or credit card please print this form, complete and mail to the address above. Credit card order may also be phoned.
Name___________________________________________________Date________________
Address_____________________________________________________________________
City_________________________________________State________Zip________________
Phone_______________________________Email___________________________________
Payment Method ____Check _____Visa _____Mastercard
Credit Card#_________ _________ _________ _________Expiration date______/________
Signature____________________________________________________________________
Item Name Color Pattern Price

Quan.

Total
____________________ ______________ ______________ $_______ _____ $_______
____________________ ______________ ______________ $_______ _____ $_______
____________________ ______________ ______________ $_______ _____ $_______
____________________ ______________ ______________ $_______ _____ $_______
____________________ ______________ ______________ $_______ _____ $_______
____________________ ______________ ______________ $_______ _____ $_______

Shipping Chart for continental USA

up to $30.00 $6.00
$30.01-$80.00 $10.00
$80.01-$160.00 $14.00
over $160.00 10% of product total
Please call for quotes on shipping to points
outside the continental USA and to international destinations
SUBTOTAL $_______
TAX (VT residents, add 6% tax) $_______
SHIPPING $_______
TOTAL $_______

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