Please type or print clearly.
This will be your mailing label:
. Name _____________________________________________________________
. Company __________________________________________________________(optional)
. Address _____________________________________________________________________
. City, State, Zip ______________________________________________________________
. Country ___________________________________________________________
. Phone _________________________________________
. Fax ___________________________________________(optional)
. E-mail _________________________________________(optional)
.
____ Unsigned Bookplates
x $1.00 each within the USA (postage paid ) = $ ________________
. ____ Unsigned Bookplates x $1.50 each
within Canada (postage paid ) = $ ________________
. Illinois residents add 6.5% Sales Tax
$ ________________
. TOTAL (US funds
only) $ _______________
Payment:
Check
or Money Order enclosed, payable to Wheeler Arts
Visa
Mastercard
. Credit card #___________-___________-___________-___________
Exp. date ______/______
. Print name on card ______________________________________________
. Cardholder's Signature ______________________________________________
. Cardholder's address ____________________________________________________________
Thank
you!