Shipping Form for Original Art

The Brian MacGregor Gallery uses The UPS Store to ship merchandise purchased form our gallery. By signing below, you authorize the UPS Store to charge all packaging and shipping charges to the credit card listed below.

CLIENT NAME:

SHIPPING ADDRESS:

Is the above address the billing address for the credit card?YesNo

If billing zip code is different, please provide your billing zip code:

TELEPHONE:

EMAIL: (Please provide an email address. This will not result in spam. Instead, The UPS Store will automatically generate an email with your tracking number and a link to track your package(s).)

CREDIT CARD:

EXP. DATE:

NAME ON CARD:

ITEM DESCRIPTION:

VALUE

ITEM DESCRIPTION:

VALUE