MERCHANDISE ORDER FORM

(Print Out and Fax or Mail, or Type Order onto E-mail Page)
To send us a merchandise order by email, please click here for an email page. For each item, include the item #, a brief description ("statue", "patch"), and per-item cost, and give a final total cost of all merchandise ordered.

We do take credit cards through our shop, Visionary East, but we are not yet set up with a secure page for credit card information on this site. Therefore, we recommend that you use one of the following methods of payment:
  1. Print out this form, provide all information including your credit card information, and fax it to us at (212) 260-9454.
  2. Print out this form, provide all information including your credit card
    information or a check payable to Visionary East, and mail it to PO Box 1082, NY, NY 10013.
  3. E -mail your order to us, include your phone number, and we'll call you for your credit card information. Or e-mail the order and then call us at (212) 995-8578 and give us your card information.

NAME

ADDRESS

PHONE FAX EMAIL

ITEM # ITEM DESCRIPTION ITEM COST

TOTAL: $

To E-Mail Us, Click Here!