Lindholm - Rowley Gallery

Fax or Mail Order Form

This form may be printed out to be filled in and mailed or faxed to:
Elizabeth Rowley Gallery 766 Route 6A Box638 Dennis, MA 02646
Phone 508-385-3114 Fax 508-385-6508
www.ccpf.com

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|Qty_|_Item#_|__Product_Name___________|_Framed__|_Unframed_|_Total__|


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__________________________________________________Sub-Total|_________|


_________________________________  5% MA Tax(if applicable)|_________|


_______________________________Shipping Each Framed @45.00 |_________|


_____________________________________Each Unframed @15.00  |_________|


_______________________________________________COD ($10.00)|_________|


_______________________________________________Grand Total |_________|


Name:__________________________________________
                     

Company:________________________________________________________________


Street:___________________________________________________________________


________________________________________________________________________


City:____________________________ State:______ Zip:__________ Country:__________




Daytime Phone:_______________________________ Fax:___________________________


  

    [ ]My check or Money Order (U.S. Funds Only) made out to Elizabeth Rowley




    [ ]Purchase Order attached




    [ ]Please charge my     [ ]MasterCard  [ ]Visa  [ ] American Express




    Account #:________________________________________________Exp. Date:__________


  

    Signature:____________________________________________________________________


All artwork is subject to prior sale.
    
    Artwork to be returned for refund must be shipped back to Elizabeth Rowley Gallery at

the customers expense within three days of receipt. Artwork and framing will be examined
 
for damage before refund is made.



Thank You For Your Business!

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