Order Form

Please Print, and/or send to the following information to:

Quanah Burgess
c/o Eagle Serpent Studio
P.O. Box 611
Apache, OK. 73006

Please allow 3 weeks for deliver after reception of payment
Send cashiers check or money orders for now
Shipping and handling $4.00 for every 5 prints
Call U. S. Toll free 1-580-588-2977 for more information

CONTACT INFORMATION
First name Last name 
Street address
Address (cont.)
City
State   Zip/Postal code 
Phone xxx-xxx-xxxx
E-mail
SHIPPING
Street address
Address (cont.)
City
State Zip/Postal code 
PRODUCT
Art Description

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