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

Price._______________

Shipping (Circle One)

Send to

Bruce Holwerda

16" x 20" = 7.00

18" x 24" = 9.00

for more than one print,add 1.00 per print,
up to 3 prints per box

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

Discover/Novus

Visa

MasterCard

American Express

Checks

Date __________

Up to two framed pieces shipped for a flat rate of 25.00 (originals to be determined)

box

security code #_____

last 3 numbers on the back of your
card.