Order Form

Call toll-free to order:   1- 877-430-3639  or if you have any questions.

Or, print out and complete this order form, then mail or fax  to:

Innerglow Art Prints, 519 Brandywine Drive, West Chester, PA   19382

Fax: (877) 430-3639       [bewing3@verizon.net]

Please send me the following Limited Editions and/or merchandise:

Print Title/Panel                                   Quantity       Size                           Price

__________________________    _______      ___________         $___________     

__________________________    _______      ___________         $___________

__________________________    _______      ___________         $___________ 

           Subtotal:                                                                                          $___________

          Taxes (6% for PA Residence Only)                                                                  $___________

          TOTAL*:                                                                                              $___________

*Plus UPS ground shipping charge (FOB West Chester, PA, 19382)

My check in the amount of $__________ is enclosed.

Please charge my       Visa ___        Mastercard ___       

Account Number: ______________________________ Expiration: _______

Verification Code (3 digit number on back of card): ____________

SHIP TO:   Name:        _____________________________________

                     Address:    _____________________________________

                    City:   ____________________  State:  _________  Zip:  ____________

                    Daytime Telephone: _____________________ Email: _____________      

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