Dennis Wiskow's Auto Art Gallery
1601 Western Ave   Green Bay, WI 54303
Print and mail form to above address or FAX to 1-920-327-2277
Ordered by: Ship to:
Name: Name:
Address: Business Name:
City: Address:
State, Zip: City:
Day Phone: State, Zip:
Fax number: E-mail:
If paying by credit card, please be sure that your name and address are exactly the same as your credit card billing statement
Quantity Description Price Each Total
       
       
       
       
       
Merchandise Total  
Shipping & Handling (see below)  
WI Sales Tax 5.5%
(Wisconsin Residents Only!)
 
MN Sales Tax 6.5%
(Minnesota Residents Only!)
 
TOTAL  
Method of Payment
Check _____ Bank Check _____ Money Order ____ VISA ____ MasterCard ___ DiscoverCard ___
Card Number                                

Exp. Date __ __ - __ __   Signature(for credit card): _____________________________________

FREE SHIPPING FOR ORDERS OVER $300!
United States
$7.50 for 1-3 items
$1.00 each additional item
Canada & Mexico
$9.00 for 1-3 items
$1.00 each additional item
International
$12.00 for 1-3 items
$1.00 each additional item