Order Form |
Amfora Co. 7145 Watt Ave Ste 5 Toll free 1 800 515 1977 Tel 916 505 2722 Fax 916- 515 1639 Email sales@italartworld.com |
Order Information |
Art# |
Quantity |
Price |
Total |
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Subtotal (CA residents add sales tax) | __________ | |||
Freight | __________ | |||
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Total |
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Billing Information |
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Name _______________________________________ Phone (______)_______-________ |
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Address ___________________________________________________________________ |
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City ____________________________ State _____________ Zip _________________ |
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Email _____________________________________________________________________ | |
Credit Card (Circle one): Visa / MasterCard / American Express |
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Card# _________ _________ _________ _________ Expiration MM/YY) ___/___ |
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Signature _______________________________ Date Signed _____/_____/_____ |
Shipping Information |
Name ______________________________________ Phone (______)_______-_________ |
Address ___________________________________________________________________ |
City _____________________________ State _____________ Zip ________________ |
Special Instructions |
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