Order Request Form
Thank you for your interest in the artwork of Jack Jaubert. Your order will be complete upon our receipt of payment.
Please complete the form below.  Or you may call 225-819-1829 to place your request.  If we are not home, you can leave all you information including your credit card number and expiration date on our secure answering service.

Please keep a printed copy of this form for your records.

          Please provide the following contact information: * Required Information.

First Name*  
Last Name*    
Work Phone  
Home Phone*  
FAX   
E-mail*  

         Which prints would you like to order and how many of each?

Quantity 

Name of Print

Price

Total
  Shipping & Handling;  See Print Info for Proper Amount

*

  Total Order Amount (tax included for retail LA residents; non LA residents may be required to report in accordance with the laws of their respective states.) (Your order is complete when we receive payment.) 

Shipping Address
First Name*
Last Name*
Phone
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country

E










  

            

			
            Jack Jaubert,
            will write, in pencil, a personal message of your choice in the 
            border.  For example:  a name and/or Geaux Tigers! and/or a 
            graduation year and/or the score of some particular LSU victory, 
            making the print even more special.  If you would like the print personalized, how 
would you like it to read?

	



 

 



	
Choose Payment 
      Method Listed Below  Ca

  

    

      
      

      

      Using a 
		Credit Card -- you must MAIL OR PHONE IN YOUR ORDER
      
		Call in your order to 1-225-819-1829; indicate the print(s) 
		you would like to order, your VISA or MASTERCARD NUMBER, name on the 
		card, and its expiration date, and your shipping address.  Leave your phone number 
		AND E-MAIL ADDRESS in case we 
		need to contact you. YOU CAN LEAVE THIS INFO ON OUR SECURE ANSWERING 
		MACHINE IF WE ARE NOT AVAILABLE WHEN YOU CALL

		OR

		
- Complete the 
      form above.

      - Print the form for your records and add your VISA or MASTERCARD  
		Number and EXPIRATION DATE. 

      - Send form to: 

               
      Jack Jaubert 

   624 Woodstone 
            Drive

              
            Baton Rouge, LA 70808 

		
- Click on the 
      "Submit Form" 
      button below to complete your request. 
            

    

    

      
      
 

    

    

      
      

      

      Mailing a Check
      - Complete the 
      form above.

      - Print the form for your records. 

      - Click on the 
      "Submit Form" 
      button below to complete your request. 

      - Make Check Payable to Jack Jaubert.

      - Send payment for your request to: 

               
      Jack Jaubert 

   624 Woodstone 
            Drive

              
            Baton Rouge, LA 70808 

 		
    

    

      

    

    

      
      

      PayPal Online

      Payment Service		
      - Complete the 
      form above.

      - Click on the
            "Submit Form" 
      button below to send your print request.

		-Print the form for your records.  

      -Return to order page (it will be blank at this point).  Then scroll 
		down to the end of this page and click on PayPal rectangular Logo. 

      

            If You are 
      Familiar with PayPal...

      -Sign in to your PayPal account and click "Send Money"  and type 
      
      jack@jackjaubert.com in the recipient's email address 
      field. Enter total amount due. PayPal will walk you through the rest and 
      your payment will be sent automatically.

      

            Haven't Used 
      PayPal Before?

      Click on the PayPal logo and register as a new user. PayPal is a safe, 
      secure and free online payment service. Once registered, click "Send 
      Money" and type
            
      
      jack@jackjaubert.com
            in the 
      recipient's email address field. Enter total amount due. PayPal will walk 
      you through the rest and your payment will be sent automatically.

    

  

  



            



Click the "Submit Form" button to 
complete the order request. Click "Reset Form" to start over.







         
     
 





            		
          

          

            
            

  Pay securely with any major credit card through PayPal!

 

            		
            
            

            
            

          

          

            
            

  Pay me securely with any major credit card through PayPal!
            

             Click PayPal Logo to 
            Make Online Payment

            

            PayPal Accepts... 
  Visa 
  MasterCard 
  Discover 
  American Express 
  eCheck

          

          

            
            

        

        
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        All images, text and graphics - Copyright 
        © 
        2004 Jack Jaubert