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PERSONAL INFORMATION
Your full name:___________________________________________________
Street
Address:____________________________________________________
City:_____________________________________________________________
Country:_______________________________
Postal Code:____________________________
Phone: (______)________________ Fax: (______)______________
E-mail:_________________________________________________________
PAINTING INFORMATION
Painting Category
Number (ie BA 9 for Baffin #9)_________________________
Painting Title:______________________________________________________
What
is it you request (Original, Photo, or Reproduction Print - circle what
applies below)
[You may preview a far superior image to what you see on the Website
of most of the paintings by ordering a 8"x 10" color photo for No Charge].
- ORIGINAL
- PRINT
Image Size:________________________________________________________
Price: ____________________$Cad
Description-
use this area to describe the painting if you are unable to fill in the
above information:
__________________________________________________________________
__________________________________________________________________
PAYMENT INFORMATION
All Sales are subject to 12% HST within
BC and Ontario. US orders are tax free under NAFTA.
Please be sure to add this onto any purchases you are making.
Please make payable to Pinnacle Innovations
CREDIT CARD- VISA
and MASTERCARD ONLY
CREDIT CARD DETAILS:
Credit Card type (ie
Visa):_______________________
Credit card Customer Service phone number (on back of card):_________________
Print Cardholder Name:_______________________________________
Card Number:_______________________________________________
Card Expiration Date:_________________________________________
Address to which your credit card statement is mailed:
_____________________________
_____________________________
_____________________________
Total Amount
of purchase (please add 12% HST where applicable):$____________Cad
I declare that
I am the Cardholder above and my signature authorizes payment for the
above amount:
Signed:_________________________________________________________
FAX
ORDERS:
Once this information is completed, fax this form and credit card info
(and cheque if applicable payable to Pinnacle Innovations) to:
Pinnacle Innovations c/o Donald Flather.com
Fax: 778-340-0061.
MAIL ORDERS:
For those mailing in payment/ orders, please mail to:
Pinnacle Innovations c/o Donald Flather.com
276 B.
East Esplanade Ave. (Lane)
North Vancouver, BC V7L 1A3
Please
allow 1-4 weeks for delivery. A receipt will be sent to you.
Thank-you
for supporting the artwork of Donald Flather and the charities we help
support.
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