A Nubian Notion, Inc.

P.O. Box 190867

Boston, MA 02119

Phone: 617.445.9500   Fax:  617.445.7500

Print this order form and use it for reference when calling in your order or mail or fax it to us.

Bill To:  (Name and Address)

Name:

Name:

Address:

Address:

Address:

Address:

City:

State:

Zip:

City:

State:

Zip:

Telephone:

Telephone:

Email:

List of Items to Purchase:

Item Name:

Item#

Quantity:

Unity Price

Merchandise Total

Refer to the on-line shipping chart to determine ground-shipping charges or call us.

Merchandise Total:

Shipping:

Massachusetts Sales Tax:

Total:

Method of Payment:

Check or Money order  (Made payable to “A Nubian Notion”)

American Express

MasterCard

Visa

Signature: