A TOUCH OF THE PAST
"Old Fashioned Service With A Smile!!!"
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Billing Address:___________________________________________________________

City:______________________________State:_________ Zip:___________ - ________

E-Mail Address: __________________________________________________________

Day Phone:______________________ Eve Phone: ______________________________
Qty              Description                 Item/Order Number Sub-Total              Item Total
Billing Information
( US Funds Only  -  No C.O.D.'s )
Card # ______________________________________
Expires: _____/_____   CVV2 Code:______________
Month / Year                  Last 3 on back of card
Name On Card: _______________________________
Exactly as it appears on your card
SHIP TO ADDRESS:     (IF DIFFERENT THAN YOUR BILLING ADDRESS)

Name (Please print):____________________________________________________

Billing Address:______________________________________________________

City:__________________________ State:_______ Zip:__________ - __________

E-Mail Address: ______________________________________________________

Day Phone:_________________________ Eve Phone:_______________________
Signature: ___________________________________
© A Top Doll © A Touch Of The Past    2000-2010.   All Rights Reserved.
Qty              Description                 Item/Order Number Sub-Total              Item Total
PA Residents Add
6% Sales Tax
NY Residents Add
8%  Sales  Tax
Grand Total
Billing Information
( US Funds Only  -  No C.O.D.'s )
Card # ______________________________________
Expires: _____/_____   CVV2 Code:______________
Month / Year                  Last 3 on back of card
Name On Card: _______________________________
Exactly as it appears on your card
Make Checks / Money Orders To:

A  TOUCH  OF  THE  PAST
17517 BERWICK TURNPIKE
GILLETT,  PA.  16925 - 9658

OR You Can E-Mail to:
Order@ATopDoll.com
Signature: ___________________________________
© A Top Doll © A Touch Of The Past    2000-2012.   All Rights Reserved.
PA Residents Add
6% Sales Tax
NY Residents Add
8%  Sales  Tax
Grand Total
Make Checks / Money Orders To:

A  TOUCH  OF  THE  PAST
17517 BERWICK TURNPIKE
GILLETT,  PA.  16925 - 9658

OR You Can E-Mail to:
Order@ATopDoll.com
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