Printable Catalog Order Form

To order by mail simply fill in the appropriate blanks in the form below, then print the form with the print funtion of your web browser.

If you are concerned as to how your personal information will be used, please read our Privacy Policy

Mail the form with your check to:
Victory Temple Order Department
2630 South 11th Street
Beaumont, Texas 77701
Fax 409–842–9658 Phone 409–842–3954 x246

Fax & Mail-in Order Form

Name

Shipping Address

City State Zip

Please supply a street address and phone number if you choose UPS or FedEX as your shipper.

Billing Address

City State Zip

Your billing address must match the address on your credit card.

Phone

E-mail address

Payment type

Checks must be drawn on a US bank in US dollars.

Credit card number

Credit card expiration date

Please be sure to include both the Order # and Product Title.
QUANTITY	ORDER #	PRODUCT TITLE	UNIT PRICE	TOTAL PRICE










ADD SHIPPING TO YOUR TOTAL (see chart)
TOTAL:

Use the print function of your browser to print this form.

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