LINDA K. DELLA POALI
P.O. Box 707
Steinhatchee, Fl. 32359
Phone:(352)498-3260
Email: lkd707@bellsouth.net
Order Form for Oil Paintings:
Type information in boxes, Use File - Print, Then mail to above address with proper payment.

Buyers Information:
Name:
Address:
City: State: Zip:

Shipping Information:
(if different from above)
Name:
Address:
City: State: Zip:

Purchase Information:
Title Of Print: Quantity:
Title Of Print: Quantity:
Title Of Print: Quantity:
Title Of Print: Quantity:
Title Of Print: Quantity:
Title Of Print: Quantity:

Total Price for Prints:
Tax:
Shipping:
Total Amount:

Payment Information:

MasterCard: Visa: Personal Check:
Credit Card/Check Number:
Expiration Date:

Signed:______________________________________________________

Please make check payable to Linda K Della Poali.
When the check clears the order will be shipped.