FAX Order Form
Thank you for your order!

For every order you submit to PolishPotteryOnline.com, you will receive an email order confirmation. For your security, we will only send an order confirmation to the email address you provide. Please be sure to enter your email address correctly to ensure that you receive your order confirmation. Please note that any applicable shipping charges will be added to your order.  Sales tax is charged on orders shipped to Massachusetts addresses only.  Please be sure to enter the billing address exactly as it is on file with your credit card company, or your order may be delayed while we verify your address.

PLEASE LOOK FOR THE FOLLOWING IN YOUR CREDIT CARD STATEMENT: Admiratrade

Shipping charges are 15% of your order with a minimum of $9.95. For mailings to Canada, Alaska, and Hawaii, please add $9.95.

Please fill out this form, print it out and fax your order to 508-393-0332. 

 
Item Number Description Pattern Unit
Price		 Quantity Subtotal
Subtotal  
 
 
  Shipping
  Shipping Address
 
 
First Name:
 
Last Name:
Street Address 1:
Street Address 2:
City:
 
State:
Zip Code:
 
Phone:
Country:
 
  Shipping Options
 
  Choose Shipping Method:
  Please note that UPS does not ship to PO Boxes. 
 
  Payment  
  Payment Method  
 
 
Credit Card:
 
Card or Account Number:
Expiration Date:
 
 
  Billing Address  
 
 

Same as Shipping Address
 
 
   
 
 
First Name:
 
Last Name:
Street Address 1:
Street Address 2:
City:
 
State:
Zip Code:
 
Phone:
Country:
 
 
 
 
 
  Email Address  
 
  E-mail Address:
  
    E-mail me a copy of my order.
 
 
  Coupon or Promotional Code (optional)  
 
  If you have a coupon that can be redeemed from Polish Pottery Online , please enter the offer code in the box below.
 
 
 
  Comments (optional)  
 
  Please enter any comments or special instructions for your order:
  
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