Bryerpatch Studio Manual order form: credit cards only

Updated 1/18/10

Manual Order Form for Credit Cards (Visa, Mastercard, or Discover only)
Please do not send checks, as we cannot determine the postage rates until we know the weight of your order and your postal zone. You will be charged for actual postage only. No handling charges will be added.

Print and mail to: Bryerpatch Studio, 502 N. 5th St., Paducah KY 42001 • 270-444-8040

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ITEM	QTY	PRICE	TOTAL








Kentucky Residents add 6% sales tax:
SUBTOTAL
SHIPPING			see below *
GRAND TOTAL:			depends on shipping charges

* SHIPPING USA: Your account will be charged for the actual cost of shipping your order. Orders will be shipped by US Priority Mail or UPS ground.
*INTERNATIONAL SHIPPING: Your credit card will be charged for the actual amount of the international shipping charges. International orders will be shipped by US Priority Mail unless other arrangements have been made.
Ship to	Credit Card Information (if different)
NAME:	NAME as it appears on your credit card:
STREET ADDRESS:	STREET ADDRESS:
CITY/ST/ZIP or POSTAL CODE:	CITY/ST/ZIP:
COUNTRY:	COUNTRY:
PHONE:	CREDIT CARD #:
EMAIL:	EXPIRATION DATE #:
	YOUR SIGNATURE: