Basically Bears - Teddy Bear Ordering Form

Please provide the following contact information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
FAX
E-mail

Please provide the following ordering information:

QTY	DESCRIPTION	PRICE

	If you wish to pay by Credit Card please indicate type and contact Marie at (603) 772-5479 to provide information. This is for your security. Thank You.
Credit card	VISA MasterCard American Express
	If you wish to pay by check, you can submit this form and mail the check to: Basically Bears at Crawley Falls Antiques 159 Crawley Falls Rd Brentwood, NH 03833 (603) 642-3417 I will process your order and email you confirmation once payment has been received. Thank You, Marie and the Bears.