ORDER FORM
PRINT FRIENDLY FORM (we hope)

ADKINS WILDLIFE ART
Make check or money order payable to Charles Adkins and mail to:
SHIP TO:
Name___________________________- Charles Adkins
P.O. Box 4152
Casper, WY 82604
Street___________________________
________________________________
Total Purchase Shipping Cost
$1--$49.99
$6.00
$50--$109.99
$10.00
$110--$139.99
$15.00
$140--$154.99
$18.00
$155--and up
$25.00
City____________________________
State____________________________
Zip_____________________________
QTY
 ITEM# TITLE
 PRINT SIZE PRINT
ONLY		 PRINT
&MAT		 TOTAL
# # . x . . $
# # . x . . $
# # . x . . $
# # . x . . $
$
subtotal
Your Email______________________
$
shipping
$
GRAND TOTAL