glissando@meer.net
Perfume Paintings Music About Us Order Form
 
order form
We accept PayPal, personal checks or money orders. Please fill out the order form and indicate method of payment. If you're paying through PayPal, we will request payment through PayPal's service. Thanks for your order!

(Fields marked with "*" are required.)
Contact Information
* First Name: 
* Last Name: 
* Home Phone:  - -
* E-mail Address: 
Method of Payment*
PayPal  Personal Check  Money Order
     
Billing Information
* Address Line 1: 
Address Line 2: 
* City: 
* State: 
* Zip Code: 
Shipping Information
Same as billing address
First Name: 
Last Name: 
Address Line 1: 
Address Line 2: 
City: 
State: 
ZIP Code: 
     
Product Unit Price Quantity
Floral Song -- .25 oz. $16.00
Floral Song -- 2 oz. $35.00
Southwinds -- .25 oz. $16.00
Southwinds -- 2 oz. $35.00
Lost Roses -- .25 oz. $24.00
Lost Roses -- 2 oz. $45.00
Shipping and Handling $5.00
Total
 
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