The Groovey Art Company
1418 Crystal Lake Circle East
Pearland, TX 77584
GrooveyArt Print and Fax 0RDER FORM
Fax form to: 281 997 0279 (US Only)
Or mail it!
First Name   (as on credit card):  M.I. Last Name    (as on credit card,  use BLACK ink Please)
 
 
 
Street Address
 
City State ZIP
 
 
 
E-mail Daytime Phone
 
 

 QTY

DESCRIPTION

CODE #

PRICE EACH

AMOUNT

  standard GAF, 3-pack   SGAF3 $45.-  
  standard GAF, 6-pack   SGAF6 $84.-  
  standard GAF, 10-pack   SGAF10 $130.-  
         
TOTAL MERCHANDISE  
SHIPPING: $12.50 for a 3-pack, $14.50 for a 6-pack,  $18.50 for a a 10-pack  
   
SUBTOTAL  
8.25% Sales Tax (TX Residents Only)  
ORDER TOTAL  
ENTER  BANK CARD NUMBERS: CARD
(CIRCLE ONE)
VISA   Master Card     via PayPal
       
       
       
       
ENTER EXPIRATION DATE (MONTH & YEAR):
       

Signature: