Please send me:

Item:             Description:                                   Qty:           Price:

Gift Certificates Qty        Name on Gift   Total $ Amount

Please call or email for shipping calculation

KY Residents Please Add 6% Sales Tax     

Grand Total: 

Credit Card: Visa     Mastercard 

NOTE:  All credit card info will be done via fax or phone

Shipping Address and Billing Address

Check this Box if Shipping and Billing Address Same

Shipping Address:                                           Billing Address:

First Name:                      First Name:

Last Name:                      Last Name:

Address 1:                       Address 1: 

Address:                          Address:   

City:                               City:        

State: Select a State Not Applicable AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY    Zip:          State: Select a State Not Applicable AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip:

Phone:                            Phone:    

E-Mail:                            E-Mal:     

Please print and fax to 502-225-0310 or E-Mail request and order to sherry@sherrycrouseart.com