ORDER FORM

The UMSD Order Form

Please fill out, print and mail or fax this form to:
University of Michigan Slide Distribution Project
Department of the History of Art
519 S. State St., Room 60 Tappan Hall
Ann Arbor, Michigan 48109-1357
Telephone: (734) 764-5406, Fax: (734) 647-4121
umsd@umich.edu

SHIP TO:
BILL TO:
Please add our institution to the mailing list.

METHOD OF PAYMENT: Please pre-pay via check (made payable to the University of Michigan,) or credit card.
Check Information:
Check Number:

Credit Card Information:
If paying by credit card we require the name of the account holder as it appears on the card,
and the billing address assigned to the account. In addition, we also require the security code,
which consists of the last three or four digits following the account number on the back of the card.
If you prefer, you may telephone us and give us any of this information over the telephone.

Name as it apears on the card:
Credit Card Number: Exp. Date:
Security Code :
(Visa, Master Card or American Express)

On a separate sheet of paper provide the following information for your order.

If you are purchasing
a slide set, indicate:

Slide set title(s)
Cost of set(s)
Shiping charges
Total cost of order

If you are ordering individual slides (20 slides minimum), indicate:

For each slide
- Order number, artists last name and an abreivated title
- Whether or not you wish to purchase the details with the whole view
- Total quantity of slides per work of art
Total quantity of slides per order
Price per slide
Total cost for slides
Shipping charges
Total cost of order

Thank you for your order

Send questions or comments to: umsd@umich.edu