Order Form
Please provide the number(s) and title(s) of the art piece
you wish to order and the amount.
Mailing Address
Name:
Street
Address:
City:
Prov./State: Tel.#:
Country: Fax #:
Postal/Zip: E-Mail:
Shipping Address         ( If Different )
Name:
Street
Address:
City:
Prov./State: Tel. #:
Country: Fax #:
Postal/Zip: E-Mail:


All prices are in Canadian funds.

Image #

         Image Title

Quantity

 

Price

  

Total
x

$
=

$

x

$
=

$

x

$
=

$

x

$
=

$

Total of Above Items

$

Ontario Residents Add 8% Retail Sales Tax

$

Shipping

$

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Cheque, money order or COD

$

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All images are the property of
Rural and Urban Art®™
© Rural and Urban Art 2003
All rights reserved.

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