ORDER FORM FOR SABINA FASCIONE ALCORN'S BOTANICAL PRINTS

To order, print and fill out this order form and mail with a check or money order to:
STEPHEN ALCORN
112 West Main Street
Cambridge, New York, 12816

If you need additional information, don't hesitate to call or fax us.

Telephone (518) 677-5798
Fax: (518) 677-2526
sabina.alcorn@verizon.net
http://www.alcorngallery.com

Upon request, your purchase may be accompanied by a brief message of your choice (maximum 5 lines please).

SABINA FASCIONE ALCORN'S BOTANICAL PRINTS

COMPLETE SETS

Price per set of 12: $72.00. Shipping and handling $5.00 per set.
International air postage $20.00 for the first set, add an additional $5.00 for each additional set.

Number of sets:__________________________________________Total Price $_________

INDIVIDUAL PRINTS

Price per individual print: $12.00. Shipping and handling $3.00 for every 6 prints
International air postage $10.00

Number of individual prints:__________________________________________Total Price $_________

New York State residents, please add appropriate sales tax:___________

GRAND TOTAL: $_________________

Note that all amounts are in US$.
Checks or money orders from outside the United States must be in US$ and drawn on a United States bank.
Orders will be shipped once checks clear.

Please specify the number and identity of individual prints being ordered. Thank you.

Iris ___________________________

Lily ___________________________

Tulip __________________________

Hosta __________________________

Phlox __________________________

Pansy __________________________

Zinnia _________________________

Poppy __________________________

Hyacinth _______________________

Foxglove _______________________

Hydrangea ______________________

Bird of Paradise _______________

We need to know where to send your order, so don't forget to provide your address!

Name ________________________________________________________________

Company _____________________________________________________________

Address _____________________________________________________________

City ________________________________________________________________

State/Zip/Country ___________________________________________________

Phone _______________________________________________________________

Fax _________________________________________________________________

E-Mail ______________________________________________________________

Call or e-mail if you require specific shipping needs.

Thank you for your interest in The Alcorn Studio & Gallery.