To order, this form may be printed, filled
out and mailed to the studio.

Name:   _____________________________________________

Address:  _____________________________________________

City, State, Zipcode:  ______________________________________

Email Address:  ________________________________

(**Your email address is NEVER shared with anyone.)

Shipping Address  (only if different than above)

Name:  __________________________________________________

Address:  __________________________________________________

City, State, Zipcode:__________________________________________________

____________________________________________________________

Quantity: ______ Price: _____Total amount__________________

If you would like the print personalized by the artist, please write
what you would like here:_______________________________

__________________________________________________

NY State residents please add 8% Sales Tax: ________

Shipping charges:

Orders $0 to $125-free

Over $125 shipping charges will be determined by size.
(* An additional $2.00 is added for multiple items.)

Print(s)_______+ Tax (NY only): ____________+ Shipping:  = ___________

____________Total Amount

Please make your check or money order payable to Kay Polito Studio.
After your check clears, any print you ordered will be mailed to you.

Mail completed form to:

Kay Polito Studio - 3040 Chili Avenue - Rochester, New York 14624

THANK YOU!

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All artwork, content, and images © Kay Polito 2001 - 2015

Last Updated: November 20, 2015