ORDER FORM

P.O. Box 659, Crofton, British Columbia CANADA V0R 1R0
email: Prairie Rose Impressions
Phone: 1 (250) 416-0089  Fax: 1 (250) 246-9523

ORDER FORM (for Printing)

Please fill out the following form, and submit your order. You will receive a confirmation of your order including details regarding shipping costs and delivery from Prairie Rose Impressions. Print this order form to send with your payment. Credit Card payment available soon.
* denotes required information

*NAME:

ADDRESS:

CITY:
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*EMAIL:

 




Postal Code
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Order Title/details Price Total

SPIRIT OF PRAIRIE ROSE
Limited Edition Bronze

** $3000.00  

CHIEF JOSEPH :
Limited Edition Bronze

** $2700.00  
WESTCOAST SPLENDOR:
LIMITED EDITION PRINT - 		** $200.00  
BLACKFOOT HOLY WOMAN:
LIMITED EDITION PRINT - 		** $200.00  
MAJESTIC WARRIOR:
LIMITED EDITION PRINT - 		** $150.00  
BLACK COYOTE:
LIMITED EDITION PRINT -		 ** $150.00  
SPIRIT OF PRAIRIE ROSE:
COMPUTER MOUSEPAD - coming soon 		**  
BLACKFOOT RELECTIONS:
SILK SCREEN ON CANVAS coming soon!		 *  
       
 
SUBTOTAL
    
 
*SHIPPING/INSURANCE
    
 
**SHIPPING/INSURANCE
    
 
BC Residents 7.5% PST
    
 
TOTAL
    
  
*Please contact us for details on shipping these items
**per item: Canada $8/ USA $15 / INT'L $25 (Canadian funds)
Certified Cheque Money Order In Canadian Funds, Made Payable to Prairie Rose Impressions
Please allow 8-12 weeks for delivery on Limited Edition Bronzes
Mail this form, with certified cheque or money order to:
Prairie Rose Impressions, Box 659, Crofton, British Columbia, CANADA V0R 1R0
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