ART PRINTS BY JAN ROBLIN

Title of this ArtPrint:______________________________________ #: ______

Price $_______ each. How many?_________ * Total Price for prints: $_______

                                                                                Add S&H: + 10.00

                                                                          Total cost: $ ________

Your Name: ____________________________________

Address: ________________________City___________, State ____, Zip_______

Email: ________________________________ (to confirm order) Date: ________

*If ordering different prints, include separate order blank with each new title, but only one shipping fee. (Shipping fee over $10 will be paid by artist). Include check or money order for total amount due with this order. Questions? Call (256) 766-0066

Mail to: Jan Roblin Originals, 730 Nellie Avenue, Florence, AL 35630

Please allow 2-3 weeks for delivery… Thank you!