ORION WORKS PURCHASE ORDER
                             for Prints
MAILING ADDRESS: Darlene P. Coltrain    PHONE (voice): (319) 465-4504
                 PO Box 13              Call 9 AM - 1 PM or 5 PM - 9 PM
                 Monticello IOWA 52310
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|      ID       | TITLE / DESCRIPTION            | UNIT | QTY | TOTAL |
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|_____________________________________________________ TOTAL: |_______|
|__________________________Canadian Orders add 25% surcharge: |_______|
|__________________________________________________ SUBTOTAL: |_______|
| SHIPPING AND HANDLEING: Add $3.00 for orders $40.00 or less |       |
|$4.00 for orders $90.00 or less. $5.00 for orders over $90.00|       |
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|                         Method of Payment                           |
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| ( ) Check Enclosed,                                                 |
|     Make checks payable in USA Dollars to: Darlene P. Coltrain      |
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|                          SHIPPING ADDRESS:                          |
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|    Name: __________________________________________________________ |
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| Address: __________________________________________________________ |
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|    City: __________________________________ ST: _______ ZIP: ______ |
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|   Phone: _____________________________________________________      |
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|     FAX: _____________________________________________________      |
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|   Email: __________________________________________________________ |
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