SCULPTURE ORDER FORM
1) FILL OUT BELOW ORDER FORM
2) COPY & PASTE TO EMAIL ADDRESS
3) OR PRINT AND MAIL TO ADDRESS AT BOTTOM OF THE FORM
4) ONCE YOUR PAYMENT IS VERIFIED YOU WILL BE NOTIFIED OF YOUR SHIPPING DATE
NAME: __________________________________________________________
BILLING ADDRESS: _______________________________________________
________________________________________________________________
SHIPPING ADDRESS if different from above: ___________________________
________________________________________________________________
PHONE: ________________________________________________________
EMAIL: _________________________________________________________
ITEM ORDERED: _________________________________________________
PRICE: ______________________
BASE UPGRADE: ______________________
FL Sales tax (6.5%): ______________________
Shipping charge: ______________________
TOTAL: ______________________
Paid: _____ check # _____ Credit card: VISA MC
Card # _________________________
Expiration: ______________________
3 digit security code ______________
SIGNATURE: ____________________________________________________
THANK-YOU FOR YOUR ORDER!
A portion of the proceeds from this sale goes to helping
THE RESCUE RANCH, Inc. a 501(c)3 organization –
“Focusing on wildlife conservation, rehabilitation and education -
especially for those who are gifted, challenged or physically limited.”
561-744-5902
17576 Bridle Court, Jupiter, FL 33478
email: vannoordenk@bellsouth.net