Maxnout.com Local artists David and John Seguin -------------Purchase order form---------------- When you are done filling out form, save, print, and send, along with your money, to : ----------------------------------------- Maxnout Art 5250 Roosevelt Blvd. Suite #39 Clearwater, Fl. 33760 ------------------------------- Ship to attn.: [your name] Address [where to send art] don't forget apt or lot #'s 8.5x11 1-25 = 7.50/pc : 26-50 = 6.00/pc : 51-100 = 5.00/pc Prices include S+H Money Orders, Cashiers Checks, cash... NO CHECKS!! How many Description Price ________________________________________________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ _______l__________________________l______________ ________NO CHECKS!! ____ Total :_____________ All cards come with envelopes at no cost. ========= NO CHECKS!!================== By accepting this documentation, I agree to never reproduce or sell this art in any way, unless under printed and/or written contract/consent, signed by artist. Thank you for your purchase. All materials are copy protected. Signed: Date: