Order Your Victoria Memorabilia
P.O. Box 332, Pompton Lakes, NJ  07442

(Please fill out this form, print it out, sign it "at the bottom" and
then mail it with your payment to the address above)
Personalization Name:
First Name, Initial:
Last Name:
Street Address:
City:
State or Province:
US Residents: Please use two-character abbreviation (e.g. CA) for the name of your state.
Zip or Postal Code:
Country:
The above address is a:
E-Mail Address: @
ie: JoeSmith123@aol.com
Voice Phone: ( ) Ext.
Fax: ( )
Signature:
By signing above, I declare that I am at least 18 years of age.

Please make check or money order payable to Victoria Z
Allow 6-8 weeks for delivery.  Thanks!