James T. Jones

ORDERS - Fax or Mail

Credit Card Orders or Completed checks can also be faxed or mailed with this order form.

NAME:
________________________________________________

ADDRESS:
________________________________________________

CITY:
________________________________________________

STATE: _______________    ZIP: ____________________

EMAIL ADDRESS:
____________@________________________

TELEPHONE:
# __ __ __/__ __ __/__ __ __ __

CARD NUMBER:
__ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __

CARD EXPIRATION DATE: ___/___

SIGNATURE IS REQUIRED:

X _________________________________________________

SHIP TO NAME AND ADDRESS (If different than charge to):

____________________________________________________

____________________________________________________

____________________________________________________

ORDER INFORMATION:

SIZE: ______x_______

DESCRIPTION: _______________________

ITEM NUMBER: #______________________

QUANTITY: ________

PRICE: $__________

MATTING COLOR (Use color #):________

FRAMED: __________Yes __________No

SHIPPING: $___________

TOTAL PAYMENT: $__________

James T. Jones
2216 204^th. Street N.W.
Stanwood, WA. 98292

Telephone: (360) 653-3895
Fax: (360) 654-8063

E-Mail: James@jamestjones.com