Order Form

CharlaRae

ORDER FORM

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Payment Method *

If you choose paypal please fill out the box below, put NA if your choose credit card.

Your PayPal Email *

If you choose Credit card please fill out the boxes below, put NA if you choose Paypal.

Credit Card Number *

Expiration Date *

3 DIGIT CODE ON THE BACK *

BILLING ZIP CODE *

YOUR ORDER HERE

Each piece of art has a title Please put the title in the box below. To prevent misunderstandings, I will send you an invoice that shows each piece, the item cost and total payment.

YOUR ORDER *

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order form

ORDER FORM

If you choose paypal please fill out the box below, put NA if your choose credit card.

If you choose Credit card please fill out the boxes below, put NA if you choose Paypal.

YOUR ORDER HERE

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