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Lady Hawk Gallery Ordering Form

Lady Hawk Gallery
14 Half Hollow Road, Selden, N.Y. 11784-3302

Print out this order form with your browser, print all information clearly and send it with you
payment to the address above. If you have any questions click here and email them to us.

       
 Name ________________________________________________________________________________
 Street Address_________________________________________________________  Apt # ________
 City ______________________________________  State ____________  Country __________________
 Zip Code _________________________________  Phone Number ______________________________
 Email Address _________________________________________________________________________

QUANTITY ORDERED

 ITEM DESCRIPTION

 PRICE

 TOTAL PRICE
       
       
       
       
       
       

 Make check or money order
payable in U.S funds ONLY to:

MARILYN LOBASSO

Allow 2-3 weeks for delivery

All packages shipped
U.S. Postal Service 1st Class

We use Crescent 100% Rag Mat and
Rag Surface Acid-Free Foam Core
  Subtotal  
 NY State residents add
 8.50% sales tax		  
 Shipping:
 Matted $6 per item
 Unmatted: 1 item $4.00
  each additional $1.00

 For orders outside the
 continental U.S. email
 for pricing		  
 TOTAL  

 Gallery Use Only:  __  M.O.   __  Check # _______    Date Rec. _______    Date Shipped _________   03/02