The Loaded Brush Order Form
Contact Us
(618) 224-7704
1-800-245-7505

Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Please provide the following for "THE INVITATION" information:
 

Size	10 x 13 Print Only - $50.00 18 x 21 Framed with Glass Print - $150.00 22 x 28 Canvas Print - $200.00 29 x 34 Canvas Framed -$300.00
Print  Name
Quantity	Shipping charges and tax included in price.

BILLING- If left blank, we will assume to use the address above.

	SHIPPING
Street Address
City
State/Province
Zip/Postal Code
Country
	How will you be paying?
	MasterCard  Visa  Money OrderCheck If paying by credit card, please call M-F 8am-4:30pm CST.  1-800-245-7505   Comments or Questions?