Governor's Art Show Mail Order Form

Governor's Art Show Mail Order Form -

Your Name:
-------- ____________________________________________

Billing Address:
-------- ____________________________________________

Address:
-------- ____________________________________________

City, State & Zip:
-------- ____________________________________________

Day Phone:
-------- ____________________________________________

E-mail:
-------- ____________________________________________

Ship To:
-------- ____________________________________________

Shipping address:
-------- ____________________________________________

City, State & Zip:
-------- ____________________________________________

Delivery Phone #:
-------- ____________________________________________

_____ "Repose" by Quang Ho - Unframed, S/N limited-edition Giclee print
Price INCLUDES shipping & handling
@ $165. $___________

Colorado - 2.9% Sales Tax $___________

Loveland - 3% Sales Tax $___________

Larimer Cnty. - .8% (.008) Sales Tax $___________

Subtotal: $___________

Grand TOTAL payable with order $___________

(No sales tax if shipped out of Colorado.)
Please fill out credit card information below, sign and mail to address below.

Name : ______________________________________________

Card #: ______________________________________________

Exp. Date: _________________

Signature:
I authorize the Governor's Art Show to charge my credit card for the total

amount of $ ______________

Purchased By: ______________________________________________

Please mail your signed order and make check payable to:

Loveland Rotarty Foundation
C/O Governor's Art Show Office
P.O. Box 7768
Loveland, CO 80537

E-mail questions to Judy Archibald or call the
Governor's Art Show Office: 970 663-0919

| Index | Loveland Map | 2000 Show | 2001 Show | 2002 Show | 2003 Show |

Your Name: --------		____________________________________________
Billing Address: --------		____________________________________________
Address: --------		____________________________________________
City, State & Zip: --------		____________________________________________
Day Phone: --------		____________________________________________
E-mail: --------		____________________________________________
Ship To: --------		____________________________________________
Shipping address: --------		____________________________________________
City, State & Zip: --------		____________________________________________
Delivery Phone #: --------		____________________________________________

_____	"Repose" by Quang Ho - Unframed, S/N limited-edition Giclee print Price INCLUDES shipping & handling	@	$165.	$___________
	Colorado - 2.9% Sales Tax			$___________
	Loveland - 3% Sales Tax			$___________
	Larimer Cnty. - .8% (.008) Sales Tax			$___________
	Subtotal:			$___________
	Grand TOTAL payable with order			$___________
	(No sales tax if shipped out of Colorado.) Please fill out credit card information below, sign and mail to address below.
Name :	______________________________________________
Card #:	______________________________________________
Exp. Date:	_________________
Signature:	I authorize the Governor's Art Show to charge my credit card for the total amount of $ ______________ Purchased By: ______________________________________________

	Please mail your signed order and make check payable to: Loveland Rotarty Foundation C/O Governor's Art Show Office P.O. Box 7768 Loveland, CO 80537 E-mail questions to Judy Archibald or call the Governor's Art Show Office: 970 663-0919
	\| Index \| Loveland Map \| 2000 Show \| 2001 Show \| 2002 Show \| 2003 Show \|