Please send _____ Replicas @ $27 each = $____________
Total amount enclosed: $____________
Name _____________________________________
Address ___________________________
City __________________ State ___________ ZIP _________
Phone ___________________
eMail address
______________________________________
___ Bill my VISA/MC
#___________________________ Expires____ / ____
Name on card_________________________ Signature__________________________________
Please print this page and mail or fax it to: Memphis Heritage,
Inc., 509 S. Main Street, Memphis, TN 38103; Fax 901.529.9852
To pay by check or money order, make out to Memphis Heritage and
mail along with completed form.