Claire Clark Studio
49 West 12th Street
New York, New York 10011
http://www.claireclark.com

ORDER FORM

An Asterisk (*) Indicates A Required Field

First Name: 
 *
Last Name: 
 *
Address: 
 *
City: 
 *
State: 
 *
Zip Code: 
 *
Phone #: 
E-Mail: 
 * 

*Sculpture Number


 
                           


*Title of Sculpture

 




    
Price


 $
     ,






.00

 		
                                     
                           

    
*Price of Sculpture

  










  
  

    Add Shipping: (e-mail or telephone Claire Clark


 to determine the rate for your particular sculpture)  Telephone: 1-212-255-7840 


E-mail: 
claire.clark@verizon.net

   

 
*Shipping Charge

      










  
  

    This is the total which includes the price of the sculpture plus the shipping charge.
      
    
*TOTAL

      



 


  		    


You can pay by money order or check.


To Pay By Mail: Print out this form and mail it with your money order or check to: 

      

      
Claire Clark
49 West 12th Street (4H)
New York, NY 10011 




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