ORDER FORM

JANET MANDEL ART STUDIO
695 WATERMAN RD.
KENNEDY, NY. 14747
(716)267-9525
EMAIL: JANET_MANDEL@HOTMAIL.COM

ITEM DESCRIPTION
(TITLE/FRAMED OR UNFRAMED)                                        QTY.           PRICE

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                                                               ADD 8-1/4% TAX (NY ONLY)  ___________

                                                                                            
                                                                                                SHIPPING   ___________
SHIPPING/HANDLING:
UP TO $50......$8.95
$50.01-$100...$12.95
$100-$150.....$18.95
$150.01-$250..$22.95
OVER $250 ADD 15%                                                       TOTAL_________________

 
NAME__________________________________________DATE__________

SHIPPING ADDRESS_____________________________________________

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PHONE_____________________EMAIL ADDRESS____________________

CIRCLE ONE:   VISA   MASTERCARD   DISCOVER      EXP.DATE_________

CARD NUMBER ___________________________________________________