Please complete the following form and print & mail page to
Ed Kane • Freelance Graphics • 8521 Forest Ave. SW • Lakewood, WA 98498
or Fax/call: 1-253-588-6637.
NOTE: this office will be closed from July 24 through August 17, 2005


Images Ordered:

First Name: M.I.:Last Name:
Street Address:
Street Address / Apt #:
City: State: Postal (Zip) Code:
Country:


Telephone Number with Area Code:
Payment Type: Credit Card Check (No International. Allow 2 weeks to clear) Postal Money Order
Credit Card Information: Master Card Visa
Credit Card Number:
Address as listed with your credit card account:
Street: Apartment/Unit #
City: State: Postal Code:
Expiration Date/Month: Year:
Authorization Code (last set of numbers on back of card- usually three):
Washington State Sales Tax for Washington Residents Only: Add 8.8% to total purchase price.
Amount of Purchase: Washington Sales Tax:
Total Authorized Amount to be Charged: