Ordering is easy. Print this form - Fill it out - Send it off

Price._______________

Shipping (Circle One)

Send to

Bruce Holwerda

16" x 20" = 10.00 up to 3 prints

18" x 24" = 12.00 up to 3 prints

25.00 flat rate for framed art

Name ____________________________

Address ____________________________

____________________________

____________________________

Check or Credit Card # ________________________

Phone # ____________________________

Expiration Date ____________

Signature _________________________________

Title of Artwork, Size, Mat Color (Black or Off-White)

___________________________________________

___________________________________________

Thank You

Bruce Holwerda

www.bruceholwerda.com

We Accept

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box

security code #_____

last 3 numbers on the back of your
card.