Click Art Gallery Order Form

Please print this form and MAIL with a cheque or money order, MAIL or FAX a credit card order.
Please type or print All fields CLEARLY.

Click Art Gallery
PO Box 64
UNDERWOOD
Queensland 4119 Australia
Fax: +1 413 473-7325

Your Name (first and last): ___________________________________________________

Street Address (no postal boxes): ______________________________________________

City: _____________________________ State: __________________________________

Postal Code: ______________________ Country: ________________________________

Your Email Address: ________________________________________________________

YOUR ART SELECTION:

Artist Name: __________________________________________ Price: $______________

Artwork Name: ____________________________________________________________

IF YOU HAVE A GIFT CERTIFICATE:

Number: ______________________ Password: ___________________ $______________

                                       ORDER TOTAL: (Art less Gift Certificate Value) $______________

YOUR PAYMENT METHOD: (Please circle one)
(Please make Cheques/MO's payable to CLICK ART and drawn in AUSTRALIAN DOLLARS)

I enclose my CHEQUE (CHECK)          MONEY ORDER          for AUD $______________

OR Please debit my MASTERCARD          VISACARD

Card Number: |__|__|__|__|-|__|__|__|__|-|__|__|__|__|-|__|__|__|__|

Expiry Date: _______/________

Cardholder Name: (must match ship to name): _____________________________________

Cardholder Signature: ________________________________________________________

*******************THANK YOU FOR YOUR ORDER. ********************
Your artwork will be sent when cheques are cleared. You will be notified by email when your order is shipped.