Please print this page, complete the form and mail it
with your check as shown below.
Ship Order To:
(PLEASE PRINT)
Name:
Address:
City:
State:
Zipcode:
Telephone:
Email:
Item Description
Price Per Unit
(sales tax already included)
Quantity
Total Price
Subtotal
Shipping charges +
(see table below)
TOTAL PAYMENT =
Value of
order
Shipping
per US Address
Please make check payable to: DUMBARTON HOUSE
and mail check and order form to: Dumbarton House Gift Shop
802 South Royal Street
Alexandria, VA 22314-4341
