M. AYO PORCELAIN
ORDER FORM

Sold to:

Name: ______________________________________________

Billing Address: ______________________________________

Physical Address: _____________________________________

City _____________________ State __________ Zip ________

Daytime phone: __(_____)_____________________________

Ship To Address:
(if different):

Name:_______________________________________________

Address:_____________________________________________

City _____________________ State __________ Zip ________

Gift?

• Message:_______________________________________
• Personalization:___________________________________

Subtotal: _______________________

Shipping:  FREE!!! on orders over $200 and within the continental United States. 

*Tax: __________________________

Total: __________________________

Method of Payment: (circle one)

• Check
• Mastercard
• Visa

• Account Number_________________________
• Exp. Date:___________
• Signature_______________________________

* Louisiana residents add 8.2% sales tax.

Read "Return Policy"