Order Form - Hyrum Smith
"Beloved Father & Patriarch"

A print from an original oil painting by Rebecca Connell

Name: __________________________________________________ Address: __________________________________________________ City, State, Zip: __________________________________________________ Phone Number: __________________________________________________ Size Quantity Price Artists Signature (add $3.00) Total 11 x 15 1/2   $22.00 $ $ 16 x 21 1/2   $32.00 $ $ Sub-Total  $ Shipping & Handling ($6.00 per print)  $ TOTAL  $

• Please allow 2 - 4 weeks for delivery.

• Payment by Check or Money Order Only payable to Rebecca Connell

• Print this Order Form and Mail to:

  Rebecca Connell
  2208 E Nora Street
  Mesa, AZ 85213

• If you would like to place your order by phone, please call 480-644-9303.

• For any additional questions, contact Rebecca via e-mail at: MesaConnel@aol.com

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