GoldenWheat Order Form

Unique Gifts & Hand-Painted Treasures

Order Form

Date Phone
How Did You Find Us

Name
Check / Money Order (click here)

Business (as applicable)
Credit Card (click here)

Address

Address 2
Credit Card #

City
Exp.Date-Month Year

State Zip Code -
CREDIT CARD ORDERS CAN BE SUBMITTED ELECTRONICALLY (see below)

Quan. Item # Item & Description $$ Each Total

			Sub - Total
			Sales Tax (for Virginia residents) 4.5%
			Total
			Shipping / Handling

			GRAND TOTAL

Your E-Mail Address

Complete This Form & Click on to Send Your

Credit Card Order to Our Secure E-Mail

-OR-

You Can Call Your Order to 1-757-824-0112
-OR-
Fax Your Credit Card Order to 1-757-824-0112

For Checks and Money Orders

Print & Complete Your Order Along with Payment, Then Mail to -

GoldenWheat, Inc., PO Box 308, New Church, VA 23415

Date Phone	How Did You Find Us
Name	Check / Money Order (click here)
Business (as applicable)	Credit Card (click here)
Address Address 2	Credit Card #
City	Exp.Date-Month Year
State Zip Code -	CREDIT CARD ORDERS CAN BE SUBMITTED ELECTRONICALLY (see below)