Eileen Kremen Gallery Order Form

You may order by:

We accept Visa , Mastercard, American Express , Discover, Diner's Club, Carte Blanche, JCB cards.

When ordering by telephone, fax, or postal mail, please provide all the information requested in the Online Order Form below.  

To confirm your order before we ship, we will e-mail or call you with the total cost of the item, (Sales Tax for California residents) shipping and insurance.


Print out a copy of this order form for you own reference as to which items you have ordered.


Please Place Your Order:
#
Items
Artist Item Description Price per
Item (US$)
Total (US$)

Shipping and Insurance Costs will be figured and e-mailed to you

ALL PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE

                                           California Residents add .0775% tax

Sub-total

Shipping

Tax

Total

Your Name and Shipping Address:

Important: All fields are required or your order won't be submitted.

First Name
Last Name
Address   (shipping)
City         (shipping)
Zip Code (Shipping)
State (if in US)
Country
E-MAIL address
Please type in your complete email address like this:
myname@host.com
Phone

 country code  -

  area code  -

  phone number (incl. ext.)

BILLING address

on credit card

Method of Payment

Please choose your method of payment for this order:

Personal check If you choose to pay by check please print this page,
send you order via mail to this address and enclose the
cheque payment:
my name, address, city, state, zip, country
Credit card
VISA
MasterCard                           
American Express       
Discover
Diner's Card
Carte Blanche
JCB Card
Name as shown on card:
Credit card No.
Valid until:

                                   

Thank you for choosing our company!

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