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We apologize for the inconvenience. Please print this form and fax or mail it. Thank you.

P.O. Box 717
Ely, Nevada 89301
702-289-8043 • 702-289-3919 fax
From (e-mail address)_______________________________________
Your Name:_______________________________________
Your Phone#:
In case of questions:		_______________________________________
Your Address:_______________________________________
City, State Zip:_______________________________________
I would like to order the following print/s____ His Majesty (8.5x11) $35.00
____ Canis Lupus Literally (8.5x11) $35.00
____ Home in the Thicket (8.5x11) $35.00
____ Song of Ely (8.5x11) $35.00
____ Keeper of the Wild (11x17) $45.00
____ Peregrine Falcon (11x17) $45.00
____ Bass (17x11) $35.00
Total Purchase Price$________________________
How would you like to pay?____ Check or Money Order.
____ Credit Card (fill out information below)
 Credit Card Number
_________________________________		 Visa ___ Mastercard ___
 Expiration Date
___________________		Name on credit card
________________________
Your credit card authorization and receipt will be e-mailed (if e-mail address is provided) or mailed to you.
Allow 7-10 working days for delivery of your prints. Thank You!
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