VIETWAY

-FAX ORDER FORM-Fax Info Line

Send your Order form through fax :

Just fill this form and print it using your browser printing facility.

France : +33 (0) 1 46 66 26 64

The fax will be printed on your printer and you will be able to send it.

USA: +1 (801 )640-9597

Mr Mrs Ms
Surname :
Given Name :

Company : Job Title :

Address1 :
Address2 :
Zip/Post Code : City :
State/Province: Country :

Activity :

Tel : Fax : E-mail :
Mobile Tel : Company Web :

I order

Painting title:

Item Number

Artist Name

Price in US Dollars

   
Sub Total US Dollars US $
Bank transfer charge US $ does not apply to Credit Card
Shipping & insurance worldwide US $

TOTAL AMOUNT

US $

Please charge my credit card :

Visa Eurocard/Mastercard
Credit Card Number : Expiration date :
Name as appears on card :

Fax it back to AMC-COM (France)

+33 (0) 1 46 66 26 64

VIETART (USA) office

+1 (801 )640-9597

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WEBMASTER : info@vietart.com

Last Revised:27-jan-2003
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