David Charvet Studios Fax/Mail Order Form:
FAX TO: 503-892-9191
Please PRINT ALL INFORMATION CLEARLY
Date: ________________________
Name: ____________________________________________________________
Shipping Address: __________________________________________________
_________________________________________________________________
_________________________________________________________________
Telephone: ______________________ Fax: ______________________________
E-Mail Address: ____________________________________________________
Qty: Item Description (include color, etc.) Price
____ ___________________________________________________________
____ ___________________________________________________________
____ ___________________________________________________________
____ ___________________________________________________________
Sub Total: _______________
Shipping: _______________
TOTAL: _______________
__ Check/Money order enclosed
Card Type (please check) ___VISA ___MASTERCARD ___AMERICAN EXPRESS
CARD # ________________________________ Expires: ___/____
Name on card: ______________________________________________________
Authorized Signature: ________________________________________________