PAYMENT BY CREDIT CARD: Please fill in this form with all information required, and just click the SUBMIT button at the end of the form, or print it and post or fax it to us.
PAYMENT BY CHEQUE: Please fill in this form with all information required, print it and send it to us together with your cheque made payable to LA VAIRONNIERE GALLERY to the above address.
Within 12 hours of a secure payment, your work of art will be dispatch to you by special courier service, in hard packaging, and insured for 150% of what you payed for. We will E-mail or Fax to you all the information which will allow you to follow through Internet or by phone where your parcel is during the travel.
Surname :
First Name :
Street :
Number :
Town / City :
ZIP / Post code :
County / Province :
Country :
Telephone :
Fax :
E-mail :
Total:
CHEQUE ENCLOSED ( Please cheque payable to LA VAIRONNIERE GALLERY. Please write your full name and address on the back of the cheque )