ORION WORKS PURCHASE ORDER
                       For Original Paintings
                (Print this form. Mail or FAX your order)

MAILING ADDRESS: Orion Works              PHONE (voice): (608) 231-2040
                 2701 Euguenia Avenue     FAX:           (608) 231-2524
                 Box 343
                 Madison WI 53705

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|___________________________________________________ TOTAL: |_________|
|________________________Canadian Orders add 25% surcharge: |_________|
|________________________________________________ SUBTOTAL: |_________|
|          SHIPPING AND HANDLEING (see additional details): |         |
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|                                              GRAND TOTAL: |         |
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|                         Method of Payment                           |
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| ( ) Check Enclosed,                                                 |
|     Make checks payable in USA Dollars to: Orion Works              |
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| ( ) Credit Card ( ) VISA ( ) Master Card                            |
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| Credit Card No _____________________________ Expiation Date: ___/___|
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| Signature: _________________________________                        |
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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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