Gay Zurich , Artist email: gmz@artandsoulinc.com WEBSITE: http://www.artandsoulinc.com
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Print this form out , complete it and mail with your payment to the address above (or to your artistic personalizer).
Hostess Name_____________________ (If this applies to this order)
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| ORDERED BY: _____________________________ | |
| STREET: ________________________________ | |
| CITY/STATE/ZIP: ______________________________________ | |
| DAYTIME PHONE: _____ - ______ - ______________ |
| CREDIT CARD PAYMENT: 1VISA 1MASTERCARD | ||||||||||||||||||||||||||||||||
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| EXPIRATION DATE: ___ -___ Signature: | ||||||||||||||||||||||||||||||||
| Item | Price | Quantity | Total | |
| - | $ | . | $ | |
| - | $ | . | $ | |
| - | $ | . | $ | |
| Merchandise total | $ | |||
| Shipping | See chart | $ | ||
| Subtotal | ||||
| Tax | 5.5 % of Subtotal if ordering from Wisconsin | $ | ||
| GRAND TOTAL |
Please allow 1 week for delivery |
$ | ||
| Name of Picture: Personalization codes and information:
Mat Color: Frame: |
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