Order Form: Products with Artwork by S D Siegel
| Print this Order Form, fill it out, and mail to: | S D SIEGEL ART |
| 211 Colonial Avenue | |
| Albany, NY 12208 USA | |
| Ship to: |
| Name: Date: |
| Address: |
| City: State: Zip: |
| Daytime Phone: ( ) (Just in case we have a question) |
| E-mail Address: |
***Made to Order, allow 2-3 weeks for delivery***
| ITEM/DESCRIPTION | DICE | DARTS | OUT INTO | NIGHT/ DAY |
SUN 3 | SUN 5 | Other |
Item Price | Qty | TOTAL PRICE |
| MOUSE PAD | $13.98 | |||||||||
| COASTERS - Set of 4 | $13.98 | |||||||||
| TOTE BAG | $16.98 | |||||||||
| T-Shirt XL | $18.98 | |||||||||
| POSTER 11" X 17" | $24.98 |
| Shipping & Handling Charges: | Sub- Total |
|
| $12.00 - $24.99 $4.95 | Sales Tax (NY residents ONLY add 8%) |
|
| $25.00 - $49.99 $5.95 | Shipping and handling (see chart at left) |
|
| $50.00 - $69.99 $6.95 | Outside of USA Shipments add $6.00 |
|
| $70.00 - $99.99 $7.95 | TOTAL |
|
| $100 or more 10% | Make check or money order payable in
US dollars to: S D SIEGEL ART |
|
| Outside of USA Shipments add $6.00 | Email: ssiegel@nycap.rr.com Website: http://www. sdsiegelart.biz | |