D D Palmer portrait bust order form

D D Palmer portrait bust order form

£1895 / €2175 / US$2525
These busts are hand cast and made to order. Each edition is individually numbered.

Please allow 6-8 weeks for delivery once order has been placed.

£450 deposit required to secure order. (Or equivalent in your currency).

PayPal preferred. You'll be taken to my page once you complete and submit of this form.

Delivery to UK is included. For all other destinations it will be calculated and added to the second payment when the order is complete and is ready to ship.

The balance is then payable prior to shipping.

Thank you. From chiropractor to chiropractor, you are keeping our legacy alive!

Toby Colliver DC

+44 7771 988524

tobycolliver@gmail.com
Name

First NameLast Name
Email
example@example.com
Contact Phone Number

Country CodeArea CodePhone Number
Contact Phone Number
Please add country code as appropriate.Format: +00 0000 000000.
Shipping Address (PLEASE USE HOME ADDRESS TO HELP AVOID CUSTOMS DELAYS IF ORDERING OUTSIDE UK)

Street Address 1

Street Address

CityState / Province

Postal / Zip CodeCountry
Invoice Address (Optional). This is if you’d like a business invoice, but can always be provided at a later date.

Company Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Any special text request for the plaque (can also be arranged later):
Default is 'D.D. Palmer, 1845-1913. Founder of Chiropractic'
Please sign to confirm. Order is only placed once deposit is paid and I have received notification.
Please pay deposit via PayPal (PREFERRED METHOD).

You'll be taken to my payment page after you submit the form.

Amount due today: £450 / €510 / US$580

(Remaining balance, including any additional shipping costs, is due prior to shipping. I'll remind you at the time)
If you prefer to pay via a different method, e.g. bank transfer (BACS), tick here and I will send you the details:
Please note:

While every effort is made to keep any customs fees on shipping outside the UK to a minimum, it cannot be guaranteed.

Any fee incurred is the responsibility of the buyer.
Should be Empty: