Printable Fax and Mail Order Form

Name ___________________________________________________
Street Address _____________________________________________
City, State, Zip Code_________________________________________
Phone Number ________________________ Email ___________________________

Check enclosed (Payable to: Carol Strand-Siebers)
Visa MasterCard

Credit Card No. ______________________________
Name on Card __________________________________
Exp. Date ______________CVV2 Number____________ (the last 3 digits back of card)

Authorized Signature _________________________________________

Items

Quantity              Description                                              Price

                                                                         Subtotal ________________
                              (Actual shipping cost plus $1.00)  S/H _________________
    I use USPS Priority. Most packages will cost $5.05, email if you think your order will be larger.
                                                                    Grand Total ________________

Mail to:
SassyArtGoddess.com
c/o Carol Strand-Siebers
125 19th Ave. So.
Hopkins, MN 55343

Fax: Pending
Email Ms.Sassy@SassyArtGoddess.com
Website www.SassyArtGoddess.com