Russell Fisher Order Form |
Ordered For
| Name: |
______________________
(First)
(Last) |
Phone: |
______________________
(Area Code) (Phone Number)
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Address:
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______________________
(Number)
(Street)
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______________________
(City) (State) (Zip
Code) |
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| Picture Title:__________________ |
.................... |
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| Original Ordered:____ Print
Ordered:_____ |
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| Quanity ordered: _______ |
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| Price : |
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$________ |
| Tax 5.00 % Virginia Residents: |
|
$________ |
| Shipping & handling of one print: $15.00 |
|
$________ |
| Shipping & handling of original: please call for cost |
|
$________ |
Total:
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$________ |
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___________________________
Visa or Master Charge# |
______/______
Expiration Date month/year |
______________________________
Full Name on Credit Card |
___________________
Security Number on Back of Credit Card |
________________________________________________________
Mailing Address Associated with Credit Card- Street #, Street Name,
City, Zip Code |
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________________________________________________________
Signature
Print, then mail this form with your check or money or credit card
order to:
RUSSELL W. FISHER
104 Woodpecker Way
Afton, VA 22920
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Please allow 2-4 weeks for delivery
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