Stacy Maeda, Artist
P.O. Box 291, Wilton, CA 95693 | Phone/Fax:(916) 687-7457
Email: stacymaeda@yahoo.com | www.stacymaeda.com

ORDER FORM Date_____________________________________
Ship to: Bill to: (if different from shipping)
Name_____________________________________ Name_____________________________________
Address___________________________________ Address___________________________________
City______________________________________ City______________________________________
State_________________Zip__________________ State_________________Zip__________________
Your email address___________________________________

QUANTITY ARTWORK TITLE & ITEM DESCRIPTION UNIT PRICE TOTAL
Subtotal $
See shipping information on "Contact & Order Information" page Shipping (Prints) $
Shipping (Cards) $
CA residents add your local state tax Sales Tax $
TOTAL $

Check payment method: Check/money order
Credit card information:
Name as it appears on credit card___________________________ Amount charged $____________
Card Number_____________________________________ Expiration date (month/year)__________
Signature____________________________________ Phone (required)________________________
Submitting your order:
IMPORTANT: Payment must accompany your order.
BY PHONE: We accept credit card telephone orders during regular business hours (10 a.m. to 8 p.m. PST). If we are not there to take your order, PLEASE LEAVE A MESSAGE so that we can call you back!
BY MAIL:  Send your order to Stacy Maeda, P.O. Box 291, Wilton, CA 95693
PLEASE NOTE:  All prices subject to change without notice. Should there be a discrepancy, we'll verify your order before shipping.