Eldreth Pottery Order Form

1. Please provide the billing information:2. Please provide the shipping information (if different):
First Name  
Last Name  
Street Address  
City  
State   Zip  
Daytime Phone  
E-mail  
First Name  
Last Name  
Street Address  
Address (cont.)  
City  
State   Zip  
Have you ordered from us before? __Yes __No

4. Please provide the following ordering information:
(If you have a current brochure, simply enter information below)

Qty Item # Description/Personalization Design # Price Amount
            
            
            
            
            
            
Sub-Total  
Tax (PA 6%)  
Shipping/Handling*  
Total  

3. Billing:

Credit Card Name  
Account Number  
Expiration Date  
CVV Number (found on signature strip)  

 

*Shipping/Handling Charges:

Shipping/Handling
Under $10.00 $5.00
$10.00-24.99 $6.00
$25.00-39.99 $7.00
$40.00-59.99 $8.00
$60.00-69.99 $9.00
$70.00-79.99 $10.00
$80.00-89.99 $11.00
$90.00-99.99 $12.00
$100.00-109.99 $13.00
$110.00-129.99 $14.00
$130.00-149.99 $15.00
Shipping over $150.00 add 10%
Shipping to HI, AK call for rates

Would you like to include a gift card?  ___ Yes ___ No  If yes, please enter your message here:

  For redware, wholesale, or other ordering inquiries, please call us at: (717)-529-6241 or (888)-811-4313. M-F: 9-5 EST.

Mail this form to:
Eldreth Pottery
902 Hart Road
Oxford PA 19363
Please allow 6 to 8 weeks for delivery.