ORDER FORM

VISA visalogo (1K) MASTERCARD mstcd (1K) MONEY ORDERS and CHECKS ACCEPTED

I'm not set up for on-line ordering yet. This is a form that you can print out, then write in
your order and mail along with payment or credit card information to:
DORIS WILBUR
1330 Melody Lake Road
Willet, New York 13863

You can also place order by phone (607) 863-4572 or email me at artbydwilbur@citlink.net

If you wish to purchase an original painting please check with me first to see if it is still available.

 Name:  Phone with area code:
 Address:  Apt/Box:
 City:  State:
 Zip Code:  Country:
 email address:  

 Payment by: (check one)
Visa   Mastercard    Money Order    Personal Check
 Credit Card Number:  Expiration Date:
 Name on Card:  3 Digit Code on back:

Quantity
Print Title
Size
Mat Color
Unit Cost
Total
                 
                 
                 
                 
                 
                 
                 
                 

Sub Total:______________

Shipping and Handling:______________

New York State Sales Tax 8%: (if applicable)______________

Thankyou for supporting an American Artist!     Total Due:______________
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