Moses House Order Form

For secure on-line ordering click here.

If you would prefer to FAX (603-352-2312) or mail your order, you may print the form below and fill it out as you go through our site. And as always, we are just a phone call away (603-352-2312).

MAILING
Name:
Street address:
Address (cont.):
City:
State/Province:
Zip/Postal code:
Phone:
FAX:
E-mail:

SHIPPING - if different than above
Name:
Street address:
Address (cont.):
City:
State/Province:
Zip/Postal code:
Country:

ORDER INFORMATION
Item #	QTY	Description		Price










No Sales Tax!			Sub-Total:
Free Shipping* *Free shipping in continental U.S., except for $1.00 handling charge on orders under $10.00. Outside continental U.S., actual shipping charges will be added to order total.			Shipping:
			TOTAL:

BILLING
Credit card
Cardholder name
Card number
Expiration date

The Moses House
30 Ashuelot St • Keene, New Hampshire 03431
Phone: 603-352-2312 • Fax:603-352-2312
e-mail:info@themoseshouse.com