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Fawn Creek Gallery

Fax or by Mail Order Form

P.O. Box 1076 Meeker, Colorado 81641

Phone/Fax: 1-888-878-0955

Ship To:

Name:

Address:

City:

State:

Zip:

Phone Number Day:

Phone Number Night:

Fax Number:

Items Ordered:

Item Number

Description/Name of Artwork

Price

 

 

 

 

 

 

 

 

 

Merchandise Total

 

Shipping, Handling, and Insurance (Add $15.00 per Print / $36.00 per Framed Print)

 

Total

 
Prints are shipped "flat" (not rolled up in a tube), framed prints are boxed.

Method of Payment:

Visa
Master Card
American Express
Check Enclosed

Account Number:

Exp. Date:

Print Name Exactly as it appears on the Credit Card:

Month \ Year


 


Signature:

 

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