Weston Gallery P.O. Box 655 Carmel, CA 93921 http://www.westongallery.com Phone: (831) 624-4453 info@westongallery.com Fax: (831) 624-7190 Directions: Use your browser's "print" command to print out this form. Fill out the form. Please enclose your payment with your order. Mail form and payment to the above address. =============================O R D E R F O R M============================ *******BILLING INFORMATION******* ********SHIPPING INFORMATION******** Name:____________________________ Name:_______________________________ Address:_________________________ Address:____________________________ _________________________ ____________________________ City:____________________________ City:_______________________________ State:_______ZIP Code:___________ State:_______ZIP Code:______________ Phone:___________________________ Phone:______________________________ ==============Artist's Choice: The Photographs of Rod Dresser============== DESCRIPTION QUANTITY PRICE EACH TOTAL Deluxe Limited Edition Book and Print Set ______ $400.00 $______ SALES TAX (California residents add 7.25% sales tax) $______ SHIPPING ($25 for each book and print set) $______ TOTAL $______ Select one image title from the group below (circle one): - Ballet Shoes, Carmel, California, 1998 - Aspens, Evening, Lundy Canyon, California, 1995 - Abstract Dune II, Death Valley National Monument, California, 1992 - White Rose, Carmel, California, 1998 ========================P A Y M E N T M E T H O D========================= PAYMENT METHOD (Circle one): MasterCard Visa American Express Check CARDHOLDER SIGNATURE:_________________________________ EXP. DATE_________ CARD NUMBER:__________________________________________