Art by Bianco Order Form
Please print, fill in and mail with your check.

Title	Image Size	Price	Qty	Total Price
Send Check only in US Funds: Pat Bianco 23 Harbourside Rd. North Quincy, MA 02171	Total Item(s) Cost
	5% MA State Tax
	US/Canada S&H: $6.50
	Foreign S&H: $20.00
	Total

Ordered by: Name:
Street:
City:
State:	Zip/Postal Code:	Country:

Ship to: Check here if same as billing address: � Name:
*Street:
City:
State:	Zip/Postal Code:	Country
*Sorry, we cannot ship to a Postal Box.