MOORE CLOCKS
123 CAMELOT CRESCENT, YORKTOWN,VA  23693
www.mooreclocks.com           mooreclocks@aol.com 
TOLL FREE:  1-877-286-6313  FAX:  1-757-223-9612  

Customer Billing Address:                                                     DATE OF ORDER:         /         /       

Name:
Street Address:
City/State/Zip:
Phone & Email:

Order Details:                                  

ITEM NO.	DESCRIPTION	QTY	PRICE/PC	TOTAL
				$
				$
SUBTOTAL				$
Virginia Purchases: Add 5% Sales Tax				$
SHIPPING AND INSURANCE				$
GRAND TOTAL				$

Shipping Address:  ( Be sure to enter shipping information if different from your own )

Name:
Street Address:
City/State/Zip:
Phone & Email:

   Check/Money Order Enclosed  |___|                     Please make checks/money orders payable to:  MOORE CLOCKS

    Mastercard |___|                  Visa |___|                Discover |___|         American Express |___|

  * Required Information for credit purchases           

                      
We ship all orders via FedEx Home Delivery.^®