MUSEUM OF MODERN ART BOOK ORDER FORM -- ID# U5015
Please print this form using your browser and fax it to 1-212-333-1127.
Item no. Author/Title Quantity Price
0161 ________ / Annette Messager _____________ / ___________ / ___________
_____________ / ______________________________ / ___________ / ___________
_____________ / ______________________________ / ___________ / ___________
_____________ / ______________________________ / ___________ / ___________
___________ Merchandise total
___________ Shipping and handling (see chart below)
___________ Subtotal
___________ NY tax on subtotal
___________ Order total
MERCHANDISE TOTAL ADD
------------------- ------
Upto $20.00 $4.95
$20.01 - $40.00 $6.55
$40.01 - $60.00 $7.65
$60.01 - $80.00 $8.95
$80.01 - $100.00 $10.95
$100.01 - $150.00 $12.00
$150.01 - $200.00 $15.35
$200.01 and over $17.55
For international shipping charges, please call
212-708-9888 or fax 212-333-1127.
Bill to:
Name: ____________________________________________________________________
Address: _________________________________________________________________
City: _________________________ State: ______________ Zip: _______________
Daytime Phone: ________________________ Fax: _____________________________
Credit Card#:______________ Exp. Date: ______ Signature:__________________
Check, money order, or gift certificate enclosed for $______________ ___.
Ship to:
Name: ____________________________________________________________________
Address: _________________________________________________________________
City: _________________________ State: ______________ Zip: _______________
Daytime Phone: _____________________ Fax: ________________________________