Dick Petrie
232 Village Run Road
Boswell, PA 15531
Telephone: 412-874-0750

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Order Form
Please print out this form, fill in necessary information and mail with your check or money order.
Or, you may fill out credit card information below.
Add 6% sales tax if ordered from Pennsylvania counties except Allegheny County;
Add 7% sales tax if ordered from Allegheny County, Pennsylvania.
Prices do not include shipping, handling or applicable sales tax.
Customer Name_____________________________                    Date__________________

Address_______________________ City____________   State____ ZIP__________

Telephone: (      ) ____________________E-Mail Address: __________________________ 


Catalog #


Matte Size

Item Cost times

Quantity

Total

____" x____"

$

 


$

____" x____"

$

 


$

____" x____"

$

 


$

____" x____"

$

 


$

____" x____"

$

 


$

PA Sales Tax
(See Instructions)


$


Total

$

(Circle One)

VISA

MasterCard

Account Number

Name as it appears on your card:

____________________________________

Expiration Date:

Customer's Signature:


___________________________________


Thank You!