Your name________________________________________________________ Street ____________________________________________ Apt or Suite # ____ City _________________________ State ____ Zip __________ Country _______ Phone: Business (___)___-______ Home (___)___-______ Fax (___)___-______ E mail ____________________________________________________________ Original Paintings: Title of work:_________________________________________ Price $________ Title of work:_________________________________________ Price $________ Subtotal $________ Prints: Title of work:____________________________Qty___@ $50, Price $________ Title of work:____________________________Qty___@ $50, Price $________ Subtotal $________ Carole's Collage
Cards:
For __male or __female? Color preference _____? Qty___ @ $10, Price $_____ Desired style or theme:__abstract, __landscape, or __objects (similar to #__) For __male or __female? Color preference _____? Qty___ @ $10, Price $_____ Subtotal $______
Payment: Total from above: $__________ Shipping and handling: Add $50 for each original painting, $10 for prints, $2
for cards $__________
Texas residents add 8.25% sales tax $__________
____I enclose a check for
payment. (Personal checks accepted, but for original
Grand Total: $__________  ____ ____
Card #_____________________________________Expires___/_____ Signature:_______________________________________________
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