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 __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ __________________________________________ ______ __________ _____________ 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) _____________