Deerely Departed Order form
JD Heritage®
Deerely Departed
11115 Knoxville Rd.
Milan, IL. 61264
USA
Order online!
DeerelyDeparted.com

Call: 1-309-787-1432
Available For Credit Card Orders
 OUTSIDE CONTINENTAL US
  International orders CALL: 1-309-787-1432
 First Name Last Name
 Street Number Street Name
 City/County  
 (Complete only when you wish the merchandise to ship to another address.)
 First Name Last Name
 Street Number Street Name
 City/County  
 TELEPHONE / FAX / E-MAIL   (Order will not be shipped if a telephone number is not provided.)  
Daytime Phone (       )__Required________________
Evening Phone (        )_________________________
E-mail Address _________________________
Fax _____________________________
Page Item Color
Code
Size
Code
Qty. Description Price Ea. Total
                   
                   
                   
                   
                   
                   
                   
                   
 Do you wish a backorder? ___ Yes ___ No

 METHOD OF PAYMENT 
(No Cash or Stamps)
 INT'L Postal/Bank Money Order
 Visa®  (13-16 num)    American Express® (15 num)
 Mastercard® (16 num) 



Please include the numbers on the metallic portion of the card.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  X__________________________
MO        YR
Expiration Date Required         CARDHOLDER'S SIGNATURE
JD Heritage® makes every effort to give you the lowest price.
Merchandise prices and specifications may be subject to change without notice.

ERRORS: Descriptive, typographic, or photographic errors are subject to correction.
Total of Merchansdise Orderd    
Packaging & Delivery (required)
Standard Express (additional $6)
   
SubTotal    
Canadaian GST 7%
Orders that ship to Ontario additional 8%
   
Total Ammout enclosed    
Packaging & Delivery
Merchandise Total Standard Delivery
$0.01-$9.99 $5.95
$10.00-$49.99 $8.95
$55.00-$99.99 $11.95
$100.00-$199.99 $14.95
$200.00 & over $15.95