Order Form for Santoleri Prints

To order: You may call us at 610-995-2047 or Print this form and fax it to 610-995-2059 or Print this form and send it to the address above.
Ship to: Check here if same ___ If it is different please give detail below.
Name:_______________________ Phone___________________
Address:___________________________________________
City:___________________ State_______ Zip___________
We will ship UPS ground service unless otherwise noted.
Quantity	Name of Print	Regular, Artist Proof, or Remarqued Print	Amount





PA residents add 6% sales tax $
Shipping - $10 per order UPS Ground in the US Shipping $
Free shipping if the order is over $200 Total $
Any Special Instructions ?
Payment : ___ Check or Credit Card: ___ Visa ___ MasterCard ___ Discover ____ AMEX
Name (as on card): ______________________________
Card Number: __________________________________
Exp. Date: ___________ V-Code (Verification Code): __________ ?
Signature :_________________________________

Order Form	Date:_______________
**Artwork by Nicholas P. Santoleri - www.Artist1.com**
Pine Ridge Productions Inc. PO Box 458 Edgemont, PA. 19028		Phone: 610-995-2047 FAX: 610-995-2059