PortraitArt4U - Product Ordering Form

Use this order form to order items if you are paying by Check or Money order. After you fill out the form but before you click on "Submit" print this page. Mail the print-out along with your payment in full to:

Dayle Duffy
PortraitArt4U
P.O. Box 762
Mt. Airy, MD 21771

Please provide the following contact information:

(Required fields * )
* Name
Organization
* Street Address
* Address (cont.)
* City
* State/Province
* Zip/Postal Code
* Country
Work Phone
Home Phone
* E-mail

Please provide the following ordering information:

HOW MANY ITEM DESCRIPTION AND ORDER NUMBER TOTAL DUE

* Check here if shipping address same as above

SHIPPING ADDRESS
* Street Address
* Address (cont.)
* City
* State/Province
* Zip/Postal Code
* Country

Choose one of the following payment options: