Nauvoo Artist Purchasing Center
Mail Order Form

Mail to: Nauvoo Artist, 1 Butternut Bluff, Nauvoo, Ill 62354

Return to the Gallery

Name: ___________________________
(Please print your name as it appears on your credit card or personal check)

Shipping address:
Street: ______________________________________
City: __________________________ State: ________
Zip code: __________ Country:_________________
Day-time Phone number: (_____)_________________


Credit card billing address (where your credit card company sends your monthly billing statement):
Street: _______________________________
City: ___________________ State: __________
Zip code: ____________Country:_____________

Credit card type: VISA | MasterCard |
Card number: ____________________________________
Expiration Date: month_____/year______
CVV # ______ (on back of visa)

 List the inventory number and a brief description for each item you are purchasing, the price, and the quantity:

Inventory # Brief description Price + s/h +Sales tax (Illinois). Quantity  Item Total

Total number of items listed above: __________

$____________+___________+___________= $___________
Total amount from list +shipping/handling +sales tax (Illinois) = TOTAL AMOUNT

Signature (required for credit card purchases)............Date