BETTY   GRISHAM ~  PRINT-AND-MAIL     ORDER FORM



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Betty Grisham, Studio 17
Torpedo Factory Art Center
105 N. Union Street
Alexandria, VA 22314

Studio Phone: 703-836-5441
Email: betty@bettygrishamstudio.com
Website: www.bettygrishamstudio.com

Your name: 

Street:  							Apt. #

City: 							 State: 				Zip Code:

Daytime phone: 

Title and description of art to be purchased (painting, pastel, reproductions, etc.):	

Price of artwork (discounts of 15% apply for additional reproductions): 

Virginia residents, add 5% Virginia state & local tax: 

Add 10% shipping if applicable: 


(For framed pieces over 30" either dimension add 20% for shipping.  If unsure, contact me.)
Total art, tax (if applicable),& shipping):



Payment method (circle one):  Check or Credit Card
Check #								Total Amount:
Credit Card #
							
Expiration Date: 				

3 digit code on back:

Date of Order:
Allow two to three weeks for delivery upon receipt of payment & order. 
Shipping address, if different from the buyer's:


Name:   
Street:  										Apt. #
City: 							 		State: 				Zip Code:
Daytime phone: