| Name: | |
| Address: | |
| * | |
| City: | |
| State or Province: | |
| Zip or Postal Code: | Country: |
| Telephone: | E-Mail: |
| the origials' or reproduction's title, and type (giclée or litho) |
|
|
||||
| 1. | $ | $ | ||||
| 2. | $ | $ | ||||
| 3. | $ | $ | ||||
| 4. | $ | $ | ||||
| 5. | $ | $ | ||||
| 6. | $ | $ | ||||
| 7. | $ | $ | ||||
| 8. | $ | $ | ||||
| 9. | $ | $ | ||||
| 10. | $ | $ | ||||
| . |
subtotal
|
$ | ||||
|
. | grand total: | ||||