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$50.00 - 99.99 |
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$100.00 - 199.99
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$200.00 and over
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*TOTAL: (pieces total + shipping charges)
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SHIPPING ADDRESS: |
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*Street Address |
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*Address (cont.) |
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*City |
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*State/Province |
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*Zip/Postal Code |
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Please provide the following contact information:
*First Name
*Last Name
Business/Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
*Work Phone
*Home Phone
FAX
ACCOUNT INFORMATION:
(The following is for business accounts only.)
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Business/Company |
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*Account Number |
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PAYMENT INFORMATION:
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*Method of Payment |
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To make a payment online (all major credit cards,) please click on the PayPal banner below for simple and secure online ordering. Be sure to include the shipping charges in the total amount.
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Checks and money orders may be made out to Leslie Diamond. Once your order and payment has been received, you will receive an email confirming the order. Be sure to submit this form electronically AND print out a copy of this order form, and send it along with your payment to:
Leslie Diamond
195 Spring Street, Suite #3
NY, NY 10012
Please allow approximately 14-21 days after payment is received for custom fabrication and delivery.
