Seton Shrine Gift Shop
Order Form

Please fill out this form, print and mail it with payment to:

Seton Shrine Gift Shop
333 South Seton Avenue
Emmitsburg, MD, 21727

or Call 301-447-7122

Name:
Address:
  
City:
  
State:
  
Zip Code :
 
Phone:
  
Email:
  

Item#
Quantity
Description
Cost
   
Total Cost of Items
   
Postage & Handling (see below)
   
TOTAL:
 
Payment Information
Check enclosed
Credit Card Payment
VISA      Mastercard
Card Number
Name on Card
Security Code
Exp date
 Signature
Total Order
Amount
Postage & Handling
$.00 - 10.00
$2.50
$10.01 - 20.00
$3.50
$20.01 - 30.00
$4.50
$30.01 - 40.00
$5.50
$40.01 - 60.00
$6.50
$60.01 - 80.00
$7.50
$80.01 - 100.00
$8.50
$100.01 - Plus
$9.50