Make checks payable to:
Elias López
Mail This Order Form
To:
6107 Landrace Lane
Orlando, FL 32807
Eliasrt.com Mail In Order
Form
| Purchased
by: |
Please
Ship To: |
Name:__________________________
Co Name:______________________
Address:________________________
Address:________________________
City:________________________
Zip:________________________
Country:________________________ |
Name:__________________________
Co Name:______________________
Address:________________________
Address:________________________
City:________________________
Zip:________________________
Country:________________________ |
| Method
Of Payment: |
Check#:_____
Amount enclosed:$___________ |
Phone Number (____)
-______-_______
Fax Number (____) -______-_______
Email Address: __________________ |
| Please
supply the following items |
| Title |
Description
/ Size |
QTY. |
Price |
Total |
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Shipping and Handeling:
8x10 and 11x14 size prints($4.50)
Order more than one print at one time,
and get the same shipping price.
|
Subtotal |
$ |
| Shipping
& Handeling |
$ |
| ( FL State
residents add 6% sales Tax ) |
FL Add
6% Tax |
$ |
| Ordered by: |
Total Due |
$ |
| Approved by: |
Date: |
|
Please Note:
Any original artwork, requires additional shipping
fees. Please email
us for this information.
|
