Please print this page out and fax or mail to:                                           To Order Call:                                   

   Winstanley-Roark Fine Arts                                   Local: 508.385.4713         

   601 Main St., Rte. 6A                      or                 Toll Free: 866.385.4713

   Dennis, MA  02638

   Fax: 508.385.4714     

Ship To: ________________________________________________

Name

                ________________________________________________

             Street

             ________________________________________________

             City                                                         State                       Zip Code

Item #     __________________________________             Quantity    ___              Price (ea) $______________

             __________________________________                                 ___                                 $______________

             __________________________________                                 ___                                 $______________

             __________________________________                                 ___                                 $______________

                                                                                                                          Shipping & Insurance   $______________

                                                                                               (if applicable)      MA Sales Tax @ 5%   $______________

                                                                                                                                          TOTAL               $______________

ALL DEPOSITS ARE NON-REFUNDABLE  -  ALL SALES FINAL ON IN STORE SALES.  INTERNET SALES ARE SUBJECT TO A TWO (2) WEEK RETURN POLICY AS STATED ON OUR WEBPAGE.  ALL ART/FRAMES MUST BE RETURNED IN ITS ORIGINAL GOOD CONDITIONS. CUSTOMERS ARE RESPONSIBLE FOR ALL SHIPPING/HANDLEING CHARGES TO AND FROM THE GALLERY. 

If you receive damaged art please contact the shipper for insurance coverage, as the gallery is not responsible for art damaged in shipping.

Method of Payment

Check or Money Order  (Payable to:  Winstanley-Roark Fine Arts)        

 VISA                    MASTER CARD             AMERICAN EXPRESS                  DISCOVER

Account Number: 

Expiration Date: MO:  _____________    YR: ________________

Discover, Visa, MC 3 digit code (Found on back of card, the last three numbers in the signature box.): ________________________

American Express 4 digit code (Found on front of card above account number.):         ________________________________

Cardholders Signature:         ______________________________________________________________________

I understand that by signing this agreement I give Winstanley-Roark Fine Arts permission to charge my credit card for the amount stated above.