PURCHASE ORDER FORM

Customer: __________________________________________   Phone: __________________
Address: ___________________________________________   Postal Code: _____________
Method of Payment: Cheque payable to Paris Museum and Historical Society         Cash
Order taken by: ___________________________________ Date: ________________________

Image: (glossy photographic finish)
1. The Farm Couple 2. Two Old Gents and a Horse 3. Stopping at the Bank 4. Inside Ahren's Pottery 5. Waiting Patiently

Image Size     Small
Image # Quantity Matted @ 40 each Mat Colour Framed - Gold @ $130 Framed - Wood @ #130 Total Notes
               
               
               
               
               

Image Size     Medium
Image # Quantity Matted @ 55 each Mat Colour Framed - Gold @ $165 Framed - Wood @ #165 Total Notes
               
               
               
               
               

Image Size     Large
Image # Quantity Matted @ 100 each Mat Colour Framed - Gold @ $195 Framed - Wood @ #195 Total Notes
               
               
               
               
               
Please note - there is no applicable PST or GST TOTAL ________

Return form to: Paris Museum and Historical Society,
                       15 Curtis Avenue North,
                       Paris, ON Canada N3L 3W1
For further information: call (519) 442-9295 or email parishs@execulink.com

Office Use Only Order completed _____________ To be picked up_____________ To be delivered____________
Notes: