| 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 |
$ |
|