KohlQuest ArtSpeak  ::  Mail Order Form


DATE  ___________

Name of Non-Profit Organization (if applicable] _________________________________________

Non-Profit Organization ID NUMBER [if applicable] ______________________________________

First and Last Names _____________________________________________________________

Street Address                         _______________________________________________________

City, State, Zip Code, Country  ______________________________________________________

Email Address (for order confirmation)    ______________________________________________

Daytime Phone (Area Code first)            _______________________________________________

Shipping Address               [    ]   Check here if same as above

    Street Address               _________________________________________________________

    City, State, Zip Code, Country  ____________________________________________________

    Credit /Debit Card Number           Visa   _____________________________________________
                                                               MasterCard   ________________________________________
                                                               Discover Card  ______________________________________                           
            3-digit security code after your card number found on the back of your card  ______________

            Expiration Date ______________

Credit Card Owner's Authorization Signature __________________________________________

 Item Description
Unit Price
Item Totals

New Beginning Poster

Hole in the Garden Wall book

Sub Total

For delivery in NC add 6-1/2% sales tax

Add shipping and handling charges (see chart below)

Alaska and Hawaii  orders add $10.50



$  0.01  --  $14.99       $  4.00
  15.00  --    49.99            6.00
  50.00  --    99.99            9.00
100.00  --  199.99         14.00
200.00  --  299.99         18.00
$300 purchase and above:  call for shipping

1.  Print out this order form.  If you don't have a printer, just write all pertinent order information on a plain sheet of paper and mail or fax it with your payment.

2.  Fill in all lines.  Be sure all information you provided is accurate.

3.  Be sure to include the correct shipping and handling information before entering your final order total.

4. If you are paying by credit card, please be sure you have submitted the correct card number and expiration date and signed your name on the CREDIT CARD  OWNER AUTHORIZATION SIGNATURE line.

5. If you are mailing in your order, please include a check or U.S. Postal money order made payable to KohlQuest. 

 6 .Mail your completed order form with payment to KohlQuest , 3271 Polk County Line Road, Rutherfordton, NC 28139

Thank you for your order!

CLICK HERE to return to Order Information page.
CLICK HERE to return to KQ ArtSpeak's home page.

phone:  828.288.0730 
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Webmaster:  KohlQuest