Please print this form, fill it in, and mail it to the address below.
For the size category, price and shipping cost, go to the image(s) and click on "Size/Pricing Information."

YOUR:

Name:

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Street Address:

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City/State/Zip:

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Phone # or email address:

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SHIP TO:

Name:

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Street Address:

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City/State/Zip:

 .
ORDER:

Image #

Title

 Size

Category

 Framed/

Unframed

Price

 Shpg/

Hndlg
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Sub-total (sum of all image prices):

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Sales tax (Ohio residents only):

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Shipping/Handling (sum of all Shpg/Hndlg):

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Total amount due (make check payable to Ken Schory):

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Please mail this form to:

   Ken Schory

   44 Royal Birkdale

   Springboro, OH  45066