Fractal Print Order Form
Print this form and mail with a money order or check in $US
to:
Email Me for Address
mapper@inreach.com
Make checks or money orders payable to:
Ken Keller ($US only, please)
Name: __________________________________________
Mailing Address: __________________________________
________________________________________________
________________________________________________
City and State: ___________________________________
Zip or Postal Code: ________________________________
Country (if other than USA): _________________________
Email Address: ___________________________________
Type of Print _____________________________________
Quantity: __________
Name of Print: ____________________________________
Gallery Number: _______
Price: ________________
Subtotal: ______________
Shipping in USA $7.50
Canada $10.50
All Other Countries $25.00
Total: ________________
Make checks or money orders payable to:
Ken Keller ($US only, please)