Form Page 6

ORDER FORM

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Most items are available upon ordering. If an item is out of stock it could take 4-6 weeks to complete the order. We will confirm delivery date by email shortly after we receive your order.

To place an order:

You may print this form and fax or mail it to us, with a check or credit card information.
Or, you may submit the order electronically (minus credit card information) then either fax, call us or we will call you for credit card information.

Or, you may call in the order.

ITEM # DESCRIPTION QTY UNIT
PRICE TOTAL

BILLING TOTAL

Subtotal

Sales Tax 5.5%
Wisconsin Residents only

Shipping within USA(add 10% of subtotal)
Minimum shipping $5.00
Call or email for international shipping rates.

Total

CHARGE INFORMATION

Credit card

Cardholder name

Card number

Expiration date

ORDERED BY:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Email

SHIP TO (if different than above)

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

MAIL TO:	PHONE:	FAX:.
Johnston Gallery 245 High Street Mineral Point, WI. 53565	608.987.3787 608.987.3669 Toll-Free.... 877.404.CLAY 877.404.2529	608.987.4669

                     [Wood ]    [ Metal ]     [Glass]    [Pottery ]    [Mixed]

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Copyright 1999 Diana and Tom Johnston

BILLING TOTAL
Subtotal
Sales Tax 5.5% Wisconsin Residents only
Shipping within USA(add 10% of subtotal) Minimum shipping $5.00 Call or email for international shipping rates.
Total

	CHARGE INFORMATION
Credit card
Cardholder name
Card number
Expiration date

	ORDERED BY:
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Email

	SHIP TO (if different than above)
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country