Order Form Print and Fax order form along with payment or credit card information to: Hans Feyerabend/Atelier 3863 Shipping Avenue Miami, FL 33146 Phone/Fax 305 569 9990 Customer Information: Name: Street: City: State: Zip: E-mail: Phone: Items to order, size Price Item 1 Item 2 Item 3 Sub total FL sales tax 6.5% Shipping, handling & insurance $50.00 per original painting Shipping, handling & insurance $25.00 up to five prints Total Payment Credit Card: Name on Credit Card Credit Card Number For a secure transaction, you may submit the completed form online by clicking the send button and we will call you for payment and delivery confirmation. Billing Address Expiration Date Signature
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