ORDER FORM

TO: Painted Mountains, 44 Clyde Street, Kirn, Dunoon, Argyll.  PA23 8EQ

Cardholder Name

exactly as printed on card

 

Card Number

 

Cardholder Address

 

Start Date

 

 

 

Expiry Date

 

 

 

Security Code

 

 

 

Issue Number

 

Postcode

 

 

 

Telephone No

 

 

 

Email Address

 

 

 

 

Quantity Ref Number                         Title              Artist     Size      Price
           
           
           
           
           
           
           
           
           
           

                                                                                                                                                                               

Total  

 

Please add the cost of postage and packing calculated in the checkout.

 

           

Total Price

PLEASE MAKE CHEQUES PAYABLE TO NEIL J BARLOW

I enclose a cheque / or / please debit my credit card

Signature........................................................................        Date....................................................

Any special requirements.......................................................................................................................................................................................