PRINT MOUSE PAD ORDER FORM and INCLUDE WITH YOUR ORDER

Title

Quantity

Price

1

 As Time Goes By

___________

 $ _________

2

 Mt. Rainier

 $ _________

3

 Golden Gate Bridge

 $ _________

4

 Infrared Rose

 $ _________

5

 Grove of Trees

 $ _________

6

 Seattle's Kerry Park

 $ _________

7

 The Makah Nation

 $ _________

8

 Field of Clover

 $ _________

9

 Hemlock Stands Alone

 $ _________

10

 Cosmos

 $ _________

11

 Ozette Beach

 $ _________

12

 Watch for Ice

 $ _________

SHIPPING TOTAL

 $ _________

TOTAL

________

              $ ________           

Mouse Pads are ONLY $10 (U.S.) EACH
Shipping & Handling is ONLY $5 for up to THREE Mousepads (in U.S. Only)
International shipping rates are slightly higher

Send Check or Money Order to
Vince Gipson
PO Box 1144
Bothell, WA 98011

Delivery is Guaranteed / Please allow up to three weeks for delivery

Send my order to:

Name: _______________________________________________________

Address ______________________________________________________

Apt:   __________

City: ______________________________State : _____________________

Zip:    __________

Email:  _______________________________________________________________________