Debra VonAllmen

410 Staton Rd., Henryville, Indiana 47126

E-mail raisor@aye.net

Order Form

Please mail check or money order to the artist, Debra is unable to accept credit cards.

You may fill in this form with your check number and we will reserve the art item for ten

days. We will confirm by E-Mail whether or not the item is still available and that it is

being held for you before you send the check. This eliminates refunds and disappointments.

Item

Price

Shipping

No.

Total
Maple Leaves (Print) Image 12"X16" (1500 Printed)

25.00

3.00 ea.

Roses in February (Print) Image 12"X16" (1500 Printed)

25.00

3.00 ea.

Flower Wagon (Print) Image 12"X16" (1000 Printed)

25.00

3.00 ea

Pink Irises (Print) Image 12"X16" (1200 Printed)

25.00

3.00 ea.

 The Peddler's Mules (Print) Image 13 1/2 " X 18" (500 Printed)

 35.00

 3.00ea
  

SubTotal

Indiana Sales Tax 5%

Shipping

Total

First Name Last Name

Address

Check Number 

E-MailAddress