Heath Studio - Order Form

JAN HEATH

ORIGINAL PRINTS

250 Quail Run Lane • BERKELEY SPRINGS, WV 25411

To place phone orders please call: 304.258.2482 OR 304.258.9840

ORDER FORM
Print out the form below, fill out, then mail to the address above. For wholesale information, please call.

PAYMENT:
   BY CHECK -- Payable to Jan Heath.
   BY VISA, MASTERCARD, AMERICANEXPRESS,DISCOVER
   Please include full name, card no., exp. date, and sign.

Landscapes • Barnyard • Monoprints • Dogs and other animals • Birds• Figures
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Name:

Date:

Address:

City, State, ZIP:

Phone:

Credit Card:

__ Visa; __ Mastercard; __ American Express; __ Discover

Account No:

Exp. Date:

Signature:

__________________________________________

Code #

DESCRIPTION	QTY	PRICE MATTED / size	TOTAL

		AMOUNT OF ORDER
	prints 9x12- 11x14 shipping 1-2 prints $9. prints larger than 11x14 up to 16x20 size are $12 shipping for 1-2 prints prints over 16x20 to be determined, please call or email call for more info 304-258-2482	SHIPPING & HANDLING	9.00-12.00 or to be determined
janheath@jheath.com		SUBTOTAL
		WV Residents add 6% Sales Tax
		TOTAL ORDER

Name:		Date:
Address:
City, State, ZIP:		Phone:
Credit Card:	__ Visa; __ Mastercard; __ American Express; __ Discover
Account No:		Exp. Date:
Signature:	__________________________________________	Code #