Museum Store Order Form

Use this form to fax or mail your order to the Museum Store

The Studio Museum in Harlem Museum Store
144 West 125th Street
New York, NY 10027
(212) 864-4500, ext. 237
(212) 866-2324 (fax)

Date ____________

Name ________________________________________________________________

Institution/Org. _________________________________________________________

Purchase Order #____________________ Resale#______________________

Address_______________________________________________________________

City_______________________________State____________________Zip________

Daytime phone_________________________________________________________

**Circle here if you are an SMH member**

Qty Item/Title Item # Price

_____________________________________________________________________

NYC residents add 8.25%, NY State add local tax

Tax__________________

S/H__________________

Total_________________

Calculate Shipping and Handling

Please calculate, then enter total amount for *each* address.

$10.00 & under $5.50
$10.01 - $15.00 $6.00
$15.00 - $30.00 $6.50
$30.01 - $50.00 $7.00
$50.01 - $100.00 $7.50
$101.01 & over $8.00

CIRCLE Manner of Payment

Cash Check Visa Mastercard Amex

Card #_____________________________________________________Exp. Date__________________

Signature_____________________________________________________________________________

The Studio Museum in Harlem