Peregrine Galleries-Fax Order Form

FAX ORDER FORM

Marlene Vitanza
Peregrine Galleries
1133 Coast Village Road
Montecito, CA 93108

Voice: 805-969-9673
Fax: 805-565-1919
MPeregrine@aol.com

Ship to:

Name:_________________________________________________________________

Street:________________________________________________________________

City:_________________________________________ State:_____ Zip:___________

Home Phone:__________________________ Business Phone:________________________

Fax:___________________________________

Email:_____________________________ Web address:___________________________

Items & Prices

Item #_______ Description________________________________________ Price $__________

Californa residents add 7.25% sales tax Tax _____________

Shipping: $3.00_____________

Total:_____________

Bill to:

[ ] Visa [ ] Mastercard

Card Number:____________________________________ Expiration Date: ____/____

All Money Orders must be drawn on US funds. Personal checks must also be drawn on US funds.
Orders will take 7 working days to complete and will be shipped the following week.

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