Order form for "Aldie" print. Please print legibly........


  Your Name:________________________________________________________________________________
  Your Adress:_______________________________________________________________________________
                   ________________________________________________________________________________
  Phone #:___________________________________________________________________________________
  E-mail:___________________________________________________________________________________
  Number of Prints:______________

  Prints.................................................$250.00
  Shipping..............................................$   5.00
  Insurance, optional, but recomended.........
$3.00
  Total...................................................$258.00

  Tax deductible portion...........................$132.00


  I will notify you by E-mail when your print(s) are shipped.


  Please return this page with check made out to The Institute Foundation to:
  Eleanor Hartwell
  287 Campground Road
  Wilmot, New Hampshire, 03287

  Phone: 603-526-4589
  E-mail: Amazon444@hotmail.com

  There is NO sales tax in New Hampshire.


                                                                        
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