Box & Clock Fine Craft Gallery-Order Form

Clock Order Form
Please print & fill out,
mail with payment information to:
Box & Clock Gallery
17607 Wesley Chapel Rd.
Churubusco, IN 46723
fax to:
260-693-9801

Arch Top II
--10"x16"x3"......$350

Mickey
--12"x17"x5"......$375.

Arch
--12"x14"x5"......$325.

Arch Top III
--12"x17"x5"......$325.

George
--10"x22"x8"......$345.

Pierced
--10"x18"x4"......$325.

Radio
--11"x14"x5"......$345.

South West I
--10"x15.5"x4"....$325.

Arrowhead
--12"x20"x2.5"....$210.

Splayed
--11"x20"x5"......$335.

Snakes
--12"x10"x5"......$475.

South West II
--10"x15"x5.......$325.

Shell
--18"x10"x4"......$325.

Steeples
--17"x17"x4"......$325.

Sizes are approximate.

Click here for a printer
friendly PDF file.

Click image below to download Acrobat Reader.

Name_______________________________________________

Company____________________________________________

Street_______________________________________________

City________________________State______Zip____________

Ship to:_____________________________________________

___________________________________________________

Clock___________________________Price________________

mahogany, bubinga, padauk, walnut (circle one)

............................................Total Price_____________

25 % of total is required with order, remaining 75% plus shipping charges is due
before shipping. I will notify you by phone or e-mail when ready to ship with
exact shipping charges. Please allow 2-3 weeks for crafting.