Postal Order Form, MythicArt.Com Online Catalog

POSTAL FORM

PLEASE NOTE: This form is designed specifically for people who do not wish to order securely on-line.

Print this form, fill out your order, then FAX it to 707.579.1108, or mail it, along with a check or money order made out to Syverson Brown Associates, or your credit card information to:

MythicArt.com
5145 Burnham Road
Santa Rosa, California 95404.

Thank you.

Name

Address
Street
City
State
Zip Code
Phone
EMAIL

Ship to Address (if Gift, or different than above)
Name
Street
City
State
Zip Code
Phone
EMAIL

Payment Information
Card Holder Name
Visa/MasterCard
Card Number
Expiration Date

Order
Item Description	No. Ordered	Unit Cost	Line Cost





Total Order

Syversen Brown Associates ... Santa Rosa ... California
707-578-1980