Fountain Pen Hospital
The Showcase of Fine Writing Instruments
10 Warren Street
New York, NY 10007
Tel. 800-253-PENS
Fax: 212-227-5916

For Ordering or Customer Service
or 212.964.0580

Weekdays: 7:30am to 5:30pm, EST
Fax: 212.227.5916 - 24 hours
Billing Address Shipping Address (if different, or a gift)
Name: Name:

City: City:
State: Zip: State: Zip:
Tel: (day) (eve) Tel: (day) (eve)
Manufacturer Collection Item Description Nib Size Color Qty. Unit Price Total
Gift Order
Recipient's Name: Gift Message: please attach on separate sheet

Engraving Style (circle one)
Single Line Block | Double Line Script | Double Line Century

Engrave on: Cap / Barrel  
(circle one)
Please allow 4 business days for shipping of engraved items from date of order. Please call for engraving prices.  
Payment Method:
Check Money Order Credit Card
Sub Total
Card Type: Shipping  
Card Account #: Sales Tax (NY State 8.875%)  
Expiration Date:    

Name on card

Cardholder Signature
Thank you!
Shipping Options*: 
Regular UPS Ground Delivery: Rush UPS 2nd Day Air: Rush UPS Next Day Air:
Amount of Order Shipping Charge Please add $15 to UPS Ground Charges Please add $25 to UPS Ground Charges
Up to $99 $6.95 Puerto Rico, US Virgin Islands, Hawaii and Alaska - Air Ship Only
    For 2nd Day Air add $11 to UPS Ground Charges
    For Next Day Air add $21 to UPS Ground Charges
$100 to $200 $9.95
$201 to $500 $12.95
$501 to $1000 $15.95 Canada: Regular UPS Ground Delivery - $18
Over $1000 Depends on Weight For all other international shipments, please contact us for charges
* Shipping charges may vary for certain heavier items, eg. wood storage boxes. Shipments to P.O. Boxes will be sent Parcel Post at the same rates as UPS charges.