THE LVIV OPERA HOUSE - BOOK ORDER FORM
www.brama.com/shop/lvivoperabook
Fax your order with credit card info to: 509-756-6230 (or) Mail the completed form to (new address!): BRAMA, Inc. "THE LVIV OPERA HOUSE" Book PO Box 20606 Tompkin Square Station New York, NY 10009 DATE ORDERED: __________________ The Lviv Opera House _______ copy(ies) x 49.00ea = $_____________ + S&H ($8.00 in U.S.) + TAX (where applicable) NOTE: Shipping & Handling will be added to the TOTAL credit card charges. Sales Tax 8.25% will be added to New York State shipments. [ ] VISA [ ] MASTERCARD _____________________________________________ Name on credit card: ____________________________________________ Exp. date: __________ Billing Postal/Zip Code: ________________ Please provide contact information in case of problems with the order: Your telephone number: (____)_______________ E-mail ____________@________________________ SHIP TO (PRINT CLEARLY, TYPE, or USE A STICK-ON RETURN ADDRESS LABEL): ____________________________________________________________________________ NAME ____________________________________________________________________________ ADDRESS ____________________________________________________________________________ ____________________________________________________________________________ CITY, STATE ZIP [ ] INCLUDE A GIFT CARD MESSAGE: ______________________________________________________________
THANK YOU FOR YOUR ORDER!!!
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