Atlanta Art Worx

Name
Guardian (if under 18)
Street Address
Address (cont.)
City
State		Zip
Work Phone
Home Phone
E-mail

CLASS #	DESCRIPTION	START DATE

BILLING
Method of Payment	Method of PaymentVISAMasterCardCheck Check #
Cardholder name
Card number
Expiration date
Security Code

 Credit Card Billing Zip Code              Total 

How did you hear about us?

I hereby authorize Atlanta Art Worx to charge my credit card the above total.

Signature ______________________________   Date _________________                       *  Mail or fax back to 1-888-766-9441 (internet encrypted transmission)