Order

Form

Amfora Co.                                          7145 Watt Ave Ste 5
North Highlands CA 95660
Toll free 1 800 515 1977                       Tel 916 505 2722 Fax 916- 515 1639
Email sales@italartworld.com
 

Order Information
Item name

Art#

Quantity

Price

Total

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Subtotal (CA residents add sales tax)   __________
Freight __________

 

Total

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Billing Information
Please list your billing address. This is also the address to which products will be shipped unless otherwise specified below.

Name _______________________________________ Phone (______)_______-________

Address ___________________________________________________________________

City ____________________________ State _____________ Zip _________________  

Email _____________________________________________________________________

Credit Card (Circle one): Visa / MasterCard / American Express

Card# _________ _________ _________ _________ Expiration MM/YY) ___/___

Signature _______________________________ Date Signed _____/_____/_____

Shipping Information
Only complete this area if you would like the products shipped to an address other than the one listed above (i.e. a gift).

Name ______________________________________ Phone (______)_______-_________

Address ___________________________________________________________________

City _____________________________ State _____________ Zip ________________

Special Instructions
Note any special instructions below:

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