Amalthea

Fill in this form and print it from your computer to send in an order, or use our website to place an order online.
To send in a check or money order, please mail this form and the payment (made out to Florence Freedman) to:

Amalthea's Attic
40 Lakeview Drive
Mastic Beach, NY 11951
NOTE: For payments by check, your order will be processed once your check has been received and cleared the bank.
If you wish to use a credit card to pay for your order, please fill in the appropriate fields below.

BILLING ADDRESS	SHIPPING ADDRESS
Name Street Address Street Address 2 City, State Zip , Card Type Card Number Expiration Date CVN# (3 digit code on the back of your card) Daytime Phone ( ) - , ext. Evening Phone ( ) - E-mail	Check here if your billing and shipping address are the same Name Company Street Address Street Address 2 City, State Zip , Daytime Phone ( ) - , ext. Evening Phone ( ) -