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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

$500

Chester

$425

Water Lilies

$500

Three Oranges

$425

Day's Catch

$625

Tea Time

$425

Peonies and Pewter

$425

Peonies and Copper

$425

Layers

$500

Peaches and Mums

$625

Peaches

$425

Potted Cabbage

$625

Orange #1

$425

Tiger Lilies

$425

Spring Tulips

$500

Chinese Ginger

$425

White Iris

$425

Red White and Blue

$425

Amber Iris

$425

Lilies Blue Vase

$625

Daybreak

$500

Canada Goose

$500

Chocolate Mold

$425

Sub Total of Items Ordered

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