Gift Order Form - The "Historic" Village Diner

The "Historic" Village Diner Gift Order Form

Please print this form from "File" menu, fill out and mail with your check or money order to:
Historic Village Diner, 7550 N. Broadway, Red Hook, NY 12571.

*INFORMATION about person ordering (Please Print Clearly):*
Name:		Telephone No.:
Address:		Apt. No.:
City:		State:	Zip:
*SHIP TO if different than above (Please Print Clearly):*
Name:
Address:		Apt. No.:
City:		State:	Zip:
QUANTITY	GIFT ITEM	GIFT PRICE	TOTAL PRICE
__________	Ceramic Mugs	$ 6.95 (each)	$ __________
__________	Diner Coffee	$ 7.95 (1 lb. pkg.)	$ __________
__________	Large T-Shirts	$ 14.95 (each)	$ __________
__________	X-Large T-Shirts	$ 14.95 (each)	$ __________
__________	XX-Large T-Shirts	$ 14.95 (each)	$ __________
__________	Large Sweat Shirts	$ 24.95 (each)	$ __________
__________	X-Large Sweat Shirts	$ 24.95 (each)	$ __________
__________	XX-Large Sweat Shirts	$ 24.95 (each)	$ __________
__________	Post Cards	$ 8.95 (25 pack)	$ __________
__________	Diner Menus Available Soon	$ 0.00 (each)	$ __________
	TOTAL MERCHANDISE ORDERED		$ __________
	New York Residents add NYS 7.25% Sales Tax		$ __________
	Shipping & Handling Charges — Priority Mail (Standard Box)		$ 4.95
	ORDER TOTAL		$ __________

Please mail your order with check or money order payable to: Historic Village Diner

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