Order Form
Print and Fax order form along with payment or credit card information to:
Hans Feyerabend/Atelier
1942 SW 9th Street
Miami, FL 33135
Phone 305 281 6094
Customer Information:
Name:
Street:
City:
State:
Zip:
E-mail:
Phone:
Items to order, size
Price
Item 1
Item 2
Item 3
Sub total
Miami Dade county sales tax 7%
Shipping, handling & insurance (inside cont. US)
$50.00 per original painting up to size 36" x 36"
Shipping, handling & insurance
$25.00 up to five prints (inside cont. US)
Total
Payment
Credit Card:
Name on Credit Card
Credit Card Number
For a secure transaction, you may submit the completed form online by clicking the send button and we will call you for payment and delivery confirmation.
Billing Address
Expiration Date
Signature
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