	Order Catalogue

Viceroy Homes Full-Color Catalogue Order Form

$20.00 US Plus $11.00 US Shipping and Handling will be charged to your credit card.

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* Please send me a copy of the catalogue in

English French

* First Name

* Last Name

* Address Line #1

Address Line #2

* City/Town

* State

* Zip Code

* Home Phone

(xxx-xxx-xxxx)

Business Phone

(xxx-xxx-xxxx)

Fax

(xxx-xxx-xxxx)

* Email Address

* Email Address (confirm)

Lot Information

* Do you currently own a lot?

Yes No

* Where do you plan to build?

* Closest City/Town

Home Interest

Additional Comments

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