Order Form

* Your Email Address : (email must be correct or order cannot be processed)


Bill To :
* Name: Phone:
* Street: City: State: Zip Code:

Ship To (if different):
Name:
Street: City: State: Zip Code:


Order :
Find items and item names in the Photo Gallery.
(Please note: Each piece of artwork is unique. Sometimes items have already been sold -- if so, you will be informed and we will help find a replacement, if one is suitable.)

Quantity
Item Name (eg. TABLE01)
Price
 
 
 
 

Payment Information :
* Payment type: Check Money Order


Order Submission :

* All sections marked with a red * must be completed for you order to be processed correctly.

Once you submit your order, a total amount due including shipping will be emailed to you.
Please be sure to print a copy of this order before selecting the Submit button.
Once notified of the amount due, please send a copy of this form and your check or money order to:

  Jims Rustic Art
PO Box 4303
Chino Valley, AZ 86323
 


     
 

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