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Name: ___________________________________________

Company: ________________________________________

Street Addr.: ______________________________________

City: _________________________ State: ______________

Postal Code_______________ Country: ________________

Phone: ___________________________________________

E-mail Address: ___________________________________

Specify Mailing Instructions If Any : ____________________

_________________________________________________

Please Note: Only checks drawn on US banks and International Money Orders will be accepted. If payment is by credit card, please enter type of card, account number, and expiration date.

Credit Card orders may be made by phone during Gallery hours.
Gnidziejko Gallery : (207) 230-0390
Hours: Tues. - Sat. 11:00 AM to 5:00 PM Eastern Standard Time

Send e-mail

Please check: Visa ___ MasterCard ___ American Express ___

Account Number _____________________________________

Expiration Date : _____________________________________

Make Checks Payable To:	Alex Gnidziejko
Mail All Orders To:	Alex Gnidziejko 40 Main Street Camden, Maine 04843

Please Enter Quantities and Line Item Totals

Pricing For Iris Prints

Quantity

Item Price

Total ………

Garden Party

$750

Chester

$625

Water Lilies

$750

Three Oranges

$625

Day's Catch

$900

Tea Time

$625

Peonies and Pewter

$625

Peonies and Copper

$625

Layers

$750

Peaches and Mums

$900

Peaches

$625

Cabbage

$900

Orange #1

$625

Tiger Lilies

$625

Spring Tulips

$750

Gems Of The Sea

Chinese Ginger

$625

Sub Total of Items Ordered

For Maine Residents Please add 5.0 % Sales Tax

Add Shipping and Handling Charges

$25.00

Add an additional Shipping and Handling fee of US $25.00 for International Orders

Total of Order