“The Warrior Storm” Order Form
 A Giclee Print by Marla Derga

Print and mail this completed form to:   Robert Derga
                                                           11492 Forest Meadow Circle
                                                           Uniontown, OH  44685

Mr. Mrs. Ms. ________________________________________________________

Street Address _______________________________________________________

City__________________________________  State________ Zip__________ USA

Number of Prints:

Total Price of Prints @ $30.00 each

Total amount enclosed as a check or money order
made payable to "Robert Derga"

Please leave a phone number in case I need to contact you about your order:

Daytime phone number_______________________
Evening phone number _______________________
Email (only if you check at least twice a week) ________________________

 

For questions about your order, email: derga@sbcglobal.net

***The print prices listed above expire May 31, 2008***

 

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