Ausangate Creations Order Form
(We are a Non-Profit - TAX DEDUCTIBLE Organization)

 
Fax this form to:  585 697-0919
Or mail to:  Ausangate Creations
                     81 Alexander Street
                     Rochester, NY  14620 - USA		 Contact us at:
585 442-2180
or send us an e-mail
Make check or money order payable to:  Ausangate Creations
         
Name: __________________________________________________
Address: __________________________________________________
  __________________________________________________
Phone: __________________________________________________
Fax: __________________________________________________
E-mail: __________________________________________________
         
Circle the item(s) to be ordered. 
Carvings:
Incas, D-1 $199.00
Tumi, D-2 $50.00
Llama, D-3 $60.00
         
Hats:
Chullo, A-5 Brown $19.95
Chullo, A-6  $19.95
         
Jewelry:
Puma Abstract, B-1 $39.95
Puma Abstract, B-2 $39.95
Ceramic, B-3 $19.95
Bull's Horn, B-4 $32.50
Good Luck, B-5 $19.95
Good Luck, B-6 $19.95
Silver & Hematite, B-7 $29.95
Silver & Hematite, B-8  $29.95
       
Rugs:
Tocapo, C-4 $275.00
Mariposa (Butterfly), C-5 $500.00
Calendar, C-6 $275.00
         
Sweaters (call for smaller sizes):
Calendaria, A-1 $64.95 Med  Lg  XL Green or Brown
Alpaca, A-2 $64.95 Med  Lg  XL Green or Tan
Robot, A-3 $64.95 Med  Lg  XL Black or White
Chismosa, A-4 $64.95 Med  Lg  XL Black or White
         
Cost
  Total of Items Circled Above   $ _______  
  NY State Orders add 8% Sales Tax $ _______
Shipping & Handling Charges: $ _______

   $50.00 or less add $6.25
   $50.01 to $100.00 add $9.95
   $100.01 to $500.00 add $13.95
   $500.01 to $1000.00 add $32.00
   Call for Express delivery cost and purchases over $1000.00
Total: $ _______
         
Shipping Address (if different from above):
Name: __________________________________________________
Address: __________________________________________________
  __________________________________________________
Phone: __________________________________________________
         
Name on credit card: _______________________________________
Card number: ______________________________ Exp date: _________
Amount to be charged:  $_________