G.W. Odmark Order Form
FIRST NAME
___________________________
LAST NAME _______________________________
COMPANY
_______________________________
ADDRESS
_______________________________
CITY
____________________STATE _____
ZIP/POSTAL CODE _____________________________
PLEASE FILL OUT THE FOLLOWING.
AMOUNT
DESCRIPTION PRICE
____ ____________________ ______
____ ____________________ ______
____
____________________ ______
We accept Visa and Mastercard
Prints will be shipped in a tube.
CREDIT CARD INFORMATION:
NAME ON CARD: ___________________________
CREDIT CARD NO. __________________________
EXPIRATION DATE ____/_____
LAST 3 NUMBERS ON BACK OF CARD. ________
HOME PHONE ________________CELL _________________
PLEASE
PRINT THIS FORM AND MAIL TO G.W.Odmark
Art Studios, 15671 Ryan Dr. Holland, Mi.