Order Form

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Order Form

You may complete the form online or offline. Once the order form has been completed, please print a copy and send it along with your check or money order to the following address:

Churchill County Museum & Archives
1050 South Maine Street
Fallon, NV 89406

Please make checks payable to the Churchill County Museum.

Please provide the following information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail

Please provide the following ordering information:

Quantity Item Description Total
Sub-Total

Shipping

$5.00
Total Enclosed

Please provide the following shipping information if the shipping address is different than the address above.

SHIP TO:
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Thank you for your order. Please print a copy of this form, and send it along with your check or money order to the following address:

Churchill County Museum & Archives
1050 South Maine Street
Fallon, NV 89406

Please make checks payable to the Churchill County Museum.

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