Please use this form only if you do NOT want to pay by credit card.  

Please print out and complete this form and mail it with a Money Order  
(sorry, we cannot accept checks at this time) for the full amount to:                   
A Small Work of ArtŪ, 242 Meadowlark Drive, Tryon, NC 28782-2516

                 

Name: __________________________________________________________ Street Address:___________________________________________________

City:__________________________________ State:_____ Zip:____________

Important: Daytime Phone:___________________________________________________

Evening Phone:___________________________________________________

SHIP TO information (if different): Name: __________________________________________________________

Street Address:___________________________________________________

City:__________________________________ State:_____ Zip:____________


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