ORDER INFO

FIRST NAME:   MIDDLE INITIAL:   LAST NAME:
HOME ADDRESS:
CITY: STATE: ZIP CODE: -
DAYTIME PHONE: E-MAIL ADDRESS:

SHIPPING INSTRUCTIONS

DELIVERY ADDRESS:
CITY:   STATE: ZIP CODE: -

ITEM # 1

ARTIST:
TITLE:   PRICE:

ITEM # 2

ARTIST:
TITLE:   PRICE:

ITEM # 3

ARTIST:
TITLE:   PRICE:

PAYMENT INFORMATION

(PLEASE MAIL CHECK OR MONEY ORDER TO :
THE SNOW GOOSE GALLERY
470 MAIN ST.
BETHLEHEM, PA 18018-5809)

VISA  MASTERCARD  AMERICAN EXPRESS  DISCOVER
ACCOUNT NUMBER:
EXPIRATION DATE (MM/YY):

I WOULD RATHER PROVIDE CREDIT CARD INFORMATION BY PHONE.  PLEASE CALL ME.

SHIPPING AND HANDLING:

• SHIPPING CHARGES WILL VARY BASED ON SIZE AND WEIGHT (MIN. $7.50)
  PLEASE CALL OR EMAIL FOR PRICES

• NO P.O. BOXES

• NO C.O.D.'S
  

Thank you for your order!