ORDERING BY MAIL
Date: ________________
Mr. __
Name: Ms. __ ________________________________________________
Address: Street: ________________________________________________
City: ________________________________________________
State: ______________________________ Zip: ___________
Phone #: Home: (_________) __________ - _______________________
Other: (_________) __________ - _______________________
Email: (Optional): ______________________________________________
I AM PLACING MY ORDER FOR:
Title: ________________________________________________________
Artist: ________________________________________________________
Item Number: ____________________
Price: $ __________________
(If shipped to PA address, add 7% sales tax) __________________
TOTAL: $ __________________
METHOD OF PAYMENT:
___ Check (Payable to Renaissance Gallery)
___ Money Order (Payable to Renaissance Gallery)
SHIPPING ADDRESS: __ Same as above
Mr. __
Name: Ms. __ ____________________________________________________
Address: Street: ____________________________________________________
City: ____________________________________________________
State: ________________________________ Zip: ______________
Allow 7 - 10 days from receipt of order to shipping.
Thank you for your business.
- O. Box 13310
Pittsburgh, PA 15243
