The BGroupÔ Collection
of Contemporary African Art &Design


Printable Order Form


Customer Information
Name: Date:
Address: Daytime Phone:
  Evening Phone:
City, State Zip: Email:

Sales Information
Item # Title, Artist, Description
Quantity
Price
    
    
    
    
    

Subtotal: 
NC Residents Sales Tax (6%): 
Shipping & Handling: 
Total: 

Check Shipping Option: UPS Ground (7-10 days)   Federal Express (Next Day)   FedEx (3 day)  

Payment Method
MasterCard/Visa/Amex: (Circle One) Account Number Exp. Date  Code 

Name of Cardholder:  Cardholder Address (if different from above):  

I hereby authorize BGroup Contemporary African Art & Design to charge the above payment to my credit card.

SignDate


Or Mail your Check / Money Order to: BGroup, 301 Hasbrouck Drive, Apex, NC 27502

Fax This Form To: 919-363-9873