SECURE ORDER FORM

Enter your Customer Information

Name (As it appears on card)
Billing Address
City
State/Province/County
Zip or Postal Code
Country (if not US)
Daytime Phone
Evening Phone
Fax
Email Address

Order Information

Did someone help you with this order?	Jane Mebus Toczek Quincy Williams Victoria Koursaros Kelli Lucas Don Cresswell Chris Lane David T Moore
Item(s) or service ordered Include listed price(s)
Special instructions

Enter Credit Card Information

Card Type	MasterCard Visa American ExpressDiscover
Number
Expiration Date		Security number
The security number is the three digit number on the back of MC, VISA, or Discover cards and the four digit number on the front of the Amex card

Shipping Notes

Generally we use UPS to ship and for that we need a street address. If you have only a post office box, we will need to ship by US Mail. We bill our cost for shipping, handling & insurance. Carriers other than UPS or US Mail usually cost more. We will ship overseas, but we will need to contact you prior to shipping in order to confirm carrier and cost. US Mail International Priority is often the most economical option. Framed items will be shipped only if crated. Crating will be billed at cost.

Enter Shipping Information

Business or Residence?	Business Residence Service (no shipping)
Shipping Carrier	UPS U.S. Mail Federal Express Other
Other shipping carrier
Shipping Name (if different)
Shipping Address (if different)
Special instructions: (Next Day? Deliver by particular date?)