Country Store
and Florence Nightingale Gift Shoppe
Online Order Form

If you haven't done so already, go back to the store and jot down the information about the items you want to purchase. Then enter it on the form below.

To cover shipping and handling costs, $10.00 will be added to each domestic order and $20.00 to each international order (for air post). On large or bulky orders, especially outside the US, we may need to charge special shipping rates. In that case we will contact you. If your order requires separate packages, such as a poster and a mug for instance, shipping and handling will be charged for each package.

Bank cards
You can pay securely online through PayPal, using any credit card, eCheck or PayPal. (You don't need a PayPal account.) You will receive an e-mail invoice.

QuantityDescriptionItem NoSize/Style
Need more space? Just submit this order and then come back and submit a second order.

Name:
Address 1:
Address 2:
City:
State/Province:
Postal Code:
Country:
Phone:
E-Mail: Required for billing purposes

Please inscribe item(s) to:

B A C K  T O  S T O R E


H  O  M  E