Customer Order & Information Request Sheet

Please print this form and mail it to: Weil Antique Prints and Maps, 401 Sutters Mill Rd. St. Peters, MO 63376-2553
USA phone: 636-939-4970 e-mail:
cweil@weilprints.com
This will establish a customer account for you and allows you to order prints without sending payment information
across the Internet, unless you wish to do so. Please See our “CONDITIONS OF SALE” for procedures.
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Customer's Mailing & Shipping Address: (UPS requires a street address)

Name: __________________________________________________________________________

Address: ______________________________________________________ Apt#______________

________________________________________________________________________________

City: __________________________________ State: _________ Zip: ___________-___________
Country ________________________________

Daytime Phone Number: Evening:
When is the best time to call?  
E-mail Address: Mandatory on foreign requests:  
  PRICE  

Items being ordered: ____________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

SUBTOTAL __________________________________________________________________

MO SALES TAX: If ordering from MO@7.225% ___________________________________

Packing, shipping, Insurance (minimum $8.00 for 1st print)Call or E-mail for exact amount: ________________

Total: (in U. S. Funds) __________________________________________________________

Credit Card Information: Please use only MasterCard_______ or Visa_______

Card Number ____________________________ Expiration______/_____

Signature (Required on credit card orders) : ________________________________________

Request: have us send you information about:
_____________________________________________________________________________

_____________________________________________________________________________

[Janet Weil Prints] If you're looking for something special, email us.

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