Raku for You
Order Form

If you didn't find a local gallery, please print this form, then refer to our online Catalog to select the items for your order.  When you have completed the form, either:

MAIL the form to: 

  Dick McGee
  398 Arnold Road
  Shelbyville, TN  37160

Or FAX the form to Dick at:

   931-684-6784 (call first)
If you have any questions about your order, please don't hesitate to call Raku for You at 931-684-6784 or 931-205-0041 (cell).
Qty. Item Size Color Comments Price
(Please order additional items on the back of this form or on another, attached sheet of paper.)

Subtotal:

________

Shipping Charges
($15 for first piece; $5 for each additional item):

________

Total Charged to Credit Card:

________

Ship To:
First Name ____________________ Last Name _______________________ MI ____
Street Address _________________________________________________________
City ______________________ State ____________________ ZIP ___________
Phone (         ) _______________ FAX (         ) __________________
E-Mail ____________________________________

Form of Payment:
___ Check*       ___ Visa        ___ MasterCard        ___ Discover 
* PLEASE NOTE: If paying by check, please mail with this form to the above address.  Thank you! 
Card Number ___________________________ Expiration Date _____________________
Signature ______________________________ Date _________________________

Thank You for Your Order!