Order Form

We are aware of the hesitance of internet shoppers to submit their card numbers electronically, so here at Myrtlewood Mystique Gallery we ask you to submit the following information and we will contact you to get your credit card information. Or you may contact us directly after submitting your order online at : 1-541-929-3853

Please provide the following contact information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Home Phone

FAX

E-mail

Please provide the following ordering information:

QTY DESCRIPTION

SHIPPING

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

1737 Main Street, Philomath, Oregon 97370 U.S.A. Home \| The Story of Myrtlewood \| The Gallery & Map \| Our Products \| Order
Phone: (541) 929-3853		Fax: (541) 929-4991
Phone: (541) 929-3853	gallery@myrtlewood.com	Fax: (541) 929-4991