Order Form

Barbara Jensen Studio
13210 Sapphire Ridge Place
Bristow, VA 20136
703/754-9186
email:  barbarajensenstudio@yahoo.com

Name:_________________________________________________________________________

Address:______________________________________________________________________

City:_______________________________ State:______ ZIP/Postal Code:____________

Country (if not USA):_________________________ Phone:_________________________



                 Item                       Quantity   Price        Total

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						Subtotal:	  	           _____________
				      	
						MI residents add 6% Tax:     _____________

						Shipping:                    _____________

						Total:			     _____________

DO NOT SEND CASH - Checks must be drawn on a US bank in US funds

Check/Money Order Enclosed  [   ]      Visa [   ]   MC [   ]

Credit Card Number ___________________________________ Exp. Date _____________
Security Number (on back of card) _____________