Dawn Dark Mountain ~ Artist

ORDER FORM

Your Billing Address:

Name____________________________________________

Address_________________________________________

City___________________State_______Zip____________

Phone (_____)____________________________________

Email Address_____________________________________

Shipping Address:

____Business_____Residence

Name_____________________________________________

Address__________________________________________

City___________________State_______Zip_____________

Phone (_____)_____________________________________

Email Address________________________________

Please Note: Phone orders are taken During Regular Business Hours 10:00 a.m. - 7:00 p.m. CST Time. Please call 1-608-221-8692 to place a phone order or before faxing an order.

To order by mail - fill out this form and send to: Dark Mountain Studio, 5200 Maywood Road, Monona, WI 53716.

Please Note: Orders sent by Fax are Credit Card orders only - Please include all Credit Card information.

Method of Payment: ___ Check ___ Money Order ___ Master Card ___ VISA

Credit Card Number:______________________________________Exp.Date_________________

Signature______________________________________________________________________

Name as it appears on Credit Card___________________________________________________

DO NOT email credit card information.

***Foreign and Canadian Customers: U.S. Funds Only (Postal Money Order or Credit Card Information)

Qty	Title	Description of Item	Price Each	Total







Please include Email Address for an Online Order Confirmation and Shipping Charges! Shipping & Handling Charges: Packing, postage & insured delivery to each destination in the Continental U.S.A: 15% of Sale Foreign Order Surcharge: Surface.....Add 15% to Sale Air............Add 30% to Sale			Subtotal of Artwork Total$ Final	$
			Shipping & Handling (see chart)	$
			WI residents add 5.5% State Tax	$
			Total	$