SHIP TO ADDRESS:
Name ___________________________________________
           (First, Last, M.I.)
          ___________________________________________
           ( Street or P.O. Box )
           ___________________________________________
           ( City, State, Zip if USA)
            ___________________________________________
           ( Country & Mail Codes if overseas )
           ____________________________________________
           ( Daytime Telephone Number )
           ____________________________________________
           (email address-for confirmation of receipt)

Total enclosed (U.S. currency) $________________

METHOD OF PAYMENT: (CIRCLE ONE PLEASE)
Check--(Checks are acceptable but may delay order for clearance)
Money Order (Immediate Shipment)
Visa    Mastercard

Credit Card#_______________________________________ Expiration Date:_________

Signature:_________________________________________

We also accept Paypal payments as a secure method of paying online.

Return Policy:  If, for any reason, you are not satisfied, the print may be returned within
30 days of purchase for the purchase price. Please contact Assonet Art before returning
print.