ORDER FORM

Please fill out the following order form and e-mail*, or print and fax to (403) 265-5061 or mail to Van Ginkel Visuals Ltd., 61 Slopeview Drive, S.W., Calgary, Alberta, Canada, T3H 4G6. Shipping via Canada Post.

*Note: Credit card orders sent by e-mail are NOT secure; we recommend sending these orders by fax or mail.

Please indicate the number of prints requested in the box before the title of the painting (indicate AP if applicable).

=============================== GICLEES: ================================
 DON'T MOVE            TWO WAY              PRIVATE PROPERTY 
 RED ROSE              DANCE PARTNERS       CREATIVE CUTTING
 MORNING RITUAL        COFFEE BREAK         ON THE HORIZON
 CHUCK WAGON CUISINE   CIRCLE UP!           ON THE LOOKOUT

============================ OFFSET PRINTS: =============================
 AN EAGLE'S DESIRE     SILVER FEATHERS      HORSEBACK 
 OUTLAW                SUNDAY               PASSIONATE PLAY 
 THUNDER ROAD          WINNING STREAK       COWBOY CROSSING
 STICKING TOGETHER     WHITE ROSES          CHUCK WAGON CUISINE

Name:       
Address:    
Postal/ZIP: 
Phone #:      Fax #: 
Email:      
Method of payment - Cheque   Money Order   VISA 
VISA #:     
Expiration date:   Signature: 
TOTAL NUMBER OF PRINTS ORDERED - Regular Edition:   APs: 
TOTAL PAYMENT ENCLOSED (add 5% GST on Canadian orders):

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