---------------------------------------------------------------------------------------------------------------

Name: ___________________________________________

Address1: ________________________________________

Address2: ________________________________________

City & State: _____________________________________

Zip or Country Code: _______________________________

Phone Number (optional): __________________________

E-mail Address: ___________________________________

---------------------------------------------------------------------------------------------------------------

 ---------------------------------------------------------------------------------------------------------------

Which image # canvas print(s) are you ordering? and qty
Canvas prints are $220.00 each (U.S. currency)
Minnesota residents add 6.5% sales tax to your order

_________________________________ __________________

_________________________________ __________________

_________________________________ __________________

_________________________________ __________________

_________________________________ __________________

_________________________________ __________________

_________________________________ __________________

Above Listed Prints Sub-total: _______________________________

Minnesota Residence Add 6.5% Sales Tax: _____________________

Grand Total: _____________________

Special Instructions or Questions (if any): ____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Note: If you do not have a printer, write the information down on a
piece of paper and send it with a check, money order, or cashier' check.