Purchase Form for Country Store
(may be filled out online and printed for mailing or faxing)

ITEM: Qty: Price:$

ITEM: Qty: Price:$

ITEM: Qty: Price:$

ITEM: Qty: Price:$

Add $5 Shipping Charges for Canadian orders                        Total Price:$

Add $10 Shipping Charges for All other countries

 

NAME: VTCI #

MAIL ADDRESS:

CITY - STATE /PROVINCE - ZIP:

COUNTRY:   PHONE:

E-MAIL ADDRESS:

Payment enclosed. Please make check payable to: Vintage Thunderbird Club International

Please mail to: VTCI Country Store
Vintage Thunderbird Club International, Inc. C/O Beverly Wake
P.O. Box 75308 Wichita, KS 67275
Visa, Discover or Mastercard # ONLY

Expiration Date

Signature_________________________________________________