SEND COMPLETED ORDER FORM TO:

Roger Pierce
2450 Shelby Lane, Clermont, FL. 34711
CREDIT CARD ORDERS MAY BE FAXED TO: 1-352-394-4827 (If no answer call 1-352-394-3849)

Name:_________________________________________________________________________________
Street Address:__________________________________________________________________________

City:______________________________________ State:__________ Zip:________________

*If shipping address is not the same as above please indicate shipping address below.

Name:_________________________________________________________________________________
Street Address:__________________________________________________________________________
City:______________________________________ State:__________ Zip:________________
Day Phone:________________________________
Eve Phone:__________________________________

Credit Info: Visa ___ MC ___ #_____________________________________________ Exp:____________

Please circle item(s) you wish to order below.

Item #

Description: Original Print Total
GS1001 The Hill Head Not Available Unframed for $90.00  
GS1002 Bemus Point Lighthouse SOLD Not Available  
GS1003 My Marina Not Available Unframed for $100.00  
GS1004 Moon Mist Not Available Unframed for $90.00  
GS1005 Beached SOLD Unframed for $100.00  
GS2006 Old Barns of Chester #1 Framed and matted for $500.00 Unframed for $100.00  
GS2007 Sanibel Lighthouse SOLD Unframed for $100.00  
GS2008 Chester Farm Framed and matted for $500.00 Unframed for $100.00  
GS2009 Sapsucker Barn SOLD Unframed for $100.00  
GS2010 Devon Mill Framed and matted for $1000.00 Unframed for $100.00  
GS3011 Searching the Beach SOLD Unframed for $100.00  
GS3012 Lighthouse Framed for $1500.00 Unframed for $100.00  
GS3013 Old Barns of Chester #2 SOLD Unframed for $100.00  
GS3014 Peggy's Cove Lighthouse Framed and matted for $1500.00 Unframed for $100.00  
GS3015 A Chester Winter SOLD Unframed for $100.00  
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CARD NUMBER!!!

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