Mail Form To:

Nancy Klotzle - Winterberry Studio Original Serigraphs
P.O. Box 443, Yorktown, NY 10598
Phone: (914) 736-7132
State ZIP
Phone E-mail

Item Name or Number Quantity Price Each Shipping Total
Date of Order: Total Due $

Payment by: Visa, MasterCard, Check or Money Order
Credit Card # Exp. Date:

_____ Check here if you wish item to be shipped to address other than indicated above.
lease write desired shipping address on back of form. Thank you for your order...Enjoy!

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