Print-out form and mail to:
Digital Renaissance at Incredible Graphics
452 W. Commercial Street
East Rochester, NY 14445


Name__________________________________________________________

Street__________________________________________________________

City, State, Zip___________________________________________________

E-mail__________________________________________________________

Phone#________________________________


Print ID#(s) and size(s)____________________________________________

_______________________________________________________________

Check One:

Canvas Only_____ Canvas Mounted_____ Canvas Mounted & Framed______

How many_____________


Check enclosed ___


If paying with credit card please fill out the following:

Visa ___ Master Card___

Account #_______________________________________________________

Expiration date___________________________________________________

Authorized Signature______________________________________________