Image Makers - On-Line Order Form

Box 62050, 104 Regent Ave. E.
Winnipeg, Manitoba, R2C 0C0
Ph/Fax: 204-224-5305
E-mail - info@imagemakers.mb.ca

On-Line Order Form
Money Orders andAccepted

To place an order for any of the products displayed on this web site,
or to be put on our mailing list for site updates.
Please fill out the following order form.

Name:
Company:
Address:
City:	Province/State:
Postal/Zip Code:	Country:
E-mail address:
Telephone:	Fax:

Would you like to receive:	Our newsletter - Yes No
	Web site updates -Yes No

Artist	Title of Piece	Qty.

Shipping costs will be added to order and notification sent with
order confirmation.

Please select your method of payment:
Visa Money Order Sorry, no Cheque or C.O.D. orders.
Please enter your credit card information:

Name (as it appears on card)

Account Number

Expiry Date

Canadian orders are subject to 5% GST.
Manitoba orders are subject to 7% PST.

If you are paying by money order, please contact us before sending payment so that shipping charges can
be applied to your order. Print this form and include it with your payment.

Your order will be shipped when we receive your payment. Send your order to:

Image Makers
Box 62050
104 Regent Ave. E.
Winnipeg, Manitoba
R2C 0C0

Please enter any questions or comments here:

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Name (as it appears on card)
Account Number
Expiry Date