Gift Shop Order Form

There is a $5.00 minimum mail order requirement and prices and availability are subject to change without notice. To place an order, print and complete this order form. Please mail this form with your payment, or if paying with credit card you may phone 319-643-5301 or fax it to 319-643-6045. Mailing address: Giftshop/ Herbert Hoover Presidential Museum/ Box 488/ 210 Parkside Dr./ West Branch, IA 52358.

Name _______________________________________________________

Address ______________________________________________________

______________________________________________________________

City ________________________________State _______ Zip __________

Daytime Phone ____________________________

Payment Information

___Visa ___MasterCard ___ Discover ___American Express
___Check ___Money Order

Make checks payable to the Herbert Hoover Museum and include your driver's license number and issuing state. Credit card orders please send in writing, phone 319-643-5301and ask for gift shop or fax 319-643-6045.

Credit Card Number _____________________________Exp Date _______________________

Issuer of Card_______________________________________________________

Customer Signature_______________________________________________________

Shipping Address (If different from above)

Name ______________________________

Address ____________________________________________________________

__________________________________________________________________

City _________________________________ State _______ Zip _______________

Item #

Quantity

Size/
Color

Description

Price/
each

Total

Postage and Handling
*Merchandise Total*	*Shipping*
up to $15.00	$5.00
$15.01 to $30.00	$7.00
$30.01 to $50.00	$10.00
$50.01 to $100.00	$15.00
over $100.00 shipped priority mail, will advise

Subtotal

Current Hoover Association members deduct 10%

Postage & Handling (additional postage for non-US orders)

TOTAL

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