Fax Order Form

Fax To: 270-259-5049

"complete this page then print & fax"

Item #

"Click Here For Shipping Rates"  Ground Ship (1-5 Unframed Prints) - add $9.95 Ground Ship (6-10 Unframed Prints) - add $14.95 Ground Ship (11-14 Unframed Prints) - add $17.95 Ground Ship (15+ Unframed Prints) - FREE! Ground Ship (Framed Prints & Misc.) - Calculated At Time Of Shipment

No Insurance Insurance $100 - add $2.00 Insurance $200 - add $3.00 Insurance $300 - add $4.00 Insurance $400 - add $5.00 Insurance $500 - add $6.00 Insurance $600 - add $7.00 Insurance $700 - add $8.00 Insruance $800 - $9.00 Insurance $1000+ - add $10.00

Total -  

Billing Address * Required Fields		Payment Method: Card Number (16 Digits) Exp. Date (xx/xx) Card Holder Name (exactly as appears on card) CVV (last 3 digits signature line on back of card)  Please Indicate One:  PayPal  MasterCard/Visa  American Express  Discover  Money Order  Personal Check  P.O. # &
*Name:
Title:
*Street Address:
Address (cont.):
*City:
*State/Province:
*Zip/Postal Code:
*Country:
*Home Phone:
Altn. Phone:
Fax:
*E-mail:

Shipping Address Same As Billing
Name:
Title:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:

Special Instructions: