Pioneer Heritage Shoppe Mail Order Form

Text Box: Mail To:
Pioneer Heritage Shoppe
6389 Hwy 32
Park River ND 58270

Phone: 701.284.6423
Hours: Monday thru Friday 10-4 CST

E-mail: sales@pioneerheritageshoppe.com
Website: http:/www.pioneerheritageshoppe.com Text Box: Purchase Order - This form can be used for retail or wholesale mail orders. Terms are certified check only.
Print and complete this form with all your contact details and mail to our office with your certified check.

Text Box: Name:
Address:
City/Postal Code:

Text Box: Name:
Address:
City/Postal Code:
Phone:
Email:

Text Box: Order Date:

To pay by Credit Card, Please Phone In your Order.
All mail orders are required to complete our Terms of Service Agreement form online HERE

Req By	Ship When	Ship Via	FOB	Buyer	Terms Certified Check or Money Order	Tax ID Wholesale Customers Only

Quantity	Item #	Units	Description (Include color/size)	Discount %	Taxable	Unit Price	Total