PRINT THIS FORM!**Portraits by Roger Order Form**

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT (please make check or money order payable to Portraits by Roger) Portraits by Roger PO Box 224 Stillwater, MN 55082 E-Mail: rubyk@winternet.com Back To The Showcase
Circle Payment Method: Check Money Order
Name:(print & signature)
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Item Name and Description	Price Each	Quantity	Total
Adult Portrait (indicate wood or canvas & include photo)	$110.00
Child Portrait (indicate wood or canvas & include photo)	$90.00
Animal Portrait (indicate wood or canvas & include photo)	$90.00
Pet Portrait (indicate wood or canvas & include photo)	$90.00

Subtotal:
Shipping and Handling: ($7.50 X number of portraits ordered)
Iowa Residents Please Add 5% Sales Tax:
Please allow 4 - 6 weeks for delivery.		Total :