THE HEIRS STORE ORDER REQUEST FORM
"ONE STRONG VOICE"
Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Email:
*
(abc@def.com)
Phone No:
*
Cell:
*
Date:
*
(XX-XX-XXXX)
ITEMS/QTY AND TOTAL PRICE:
Item:
Qty:
Total Price:
Item:
Qty:
Total Price:
Item:
Qty:
Total Price:
Item:
Qty:
Total Price:
* YOUR ORDER WILL BE SHIPPED UPON RECEIPT OF YOUR PAYMENT
Note: You may purchase all your HEIRS merchandise by Paypal or you may mail your money orders to
HEIRS, P. O. Box 490, La Porte, TX 77572, to the attention of MRS. LAURA BATA.
Please be sure to provide us with your phone number in case we are missing any address information for direct shipping of merchandise. If you have questions, you may contact Laura Bata (pronounced Bay tah) at 281-471-6630, or
landgrant22@gmail.com
By clicking "Submit", I hereby affirm that the information listed above is accurate to the best of my knowledge.
Eileen McKenzie Fowler 2004 - 2023©
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