ORDER FORM

LOST HIGHWAY ART CO.
P.O. Box 164
Bedford Hills, NY 10507-0164
losthwyart@aol.com

 

For payments, we accept checks or money orders made out to Lost Highway Art Co.

Please complete the following form and mail to Lost Highway Art Co. using the P.O. Box address above. Or, email us with all of the information on this form. (We do not have capability for you to submit the form to us yet. Hopefully, we will very soon. Thank you for your patience!)

Orders are sent by first class mail to the address you indicate below. Lost Highway Art, Co. pays all postage and handling for U.S. orders. International orders please add $2.00 for postage. Allow 3-4 weeks for delivery.

Send to

 

Name:
Address:
City:
State:
Zip:

 

Quantity
Stock #
Description
Price Each
Line Total

 

Total for Catalog Discounts
Quantity Discount (if any)
Decals after Discount
Less Catalog Credit Coupon (enclose)
 
TOTAL FOR ORDER
 
N.Y. State Orders add 6% tax
International Orders add $2.00 postage
 
TOTAL PAYMENT

Check

Money Order