Lightsource Creations

109 East 8th St.

Medford, OR 97501

Tel. (541) 779-0942 Fax (541) 779-0896

lcreations@earthlink.net

 

Order Form

This form is intended to be printed from your computer screen and faxed, or mailed, to the address above.  If paying by check please enclose a copy of this order form with your payment even if you fax your order in first.

 

Standardized Prints

Series Available: Locomotives, Fire Engines & Rogue River Watercolors

Name of Print

(i.e. The U. P.  “Big Boy”)

Size *

(11x17, 16x36, Other)

Mat Color

A, B, C or D**

Price

Quantity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Customized Prints

Series Available: Locomotives, Fire Engines & Rouge River Watercolors

Name of Print

(i.e. The U. P.  “Big Boy”)

Size *

(11x17, 16x36, Other)

Mat Color

A, B, C or D**

Price

Quantity

 

 

 

 

 

Customization images and instructions:

 

 

 

Name of Print

(i.e. The U. P.  “Big Boy”)

Size *

(11x17, 16x36, Other)

Mat Color

A, B, C or D**

Price

Quantity

 

 

 

 

 

Customization images and instructions:

 

 

 

Name of Print

(i.e. The U. P.  “Big Boy”)

Size *

(11x17, 16x36, Other)

Mat Color

A, B, C or D**

Price

Quantity

 

 

 

 

 

Customization images and instructions:

 

 

 

Miscellaneous Items

Available Items: Voice of the Rogue Booklet & Special Requests

Description of Item

Price

Quantity

 

 

 

 

 

 

 

 

 

 

 

 

Price Total

Plus Shipping and Handling

TOTAL BILL FOR ORDER

 

 

 

 

 

 

**Mat Colors: black on grey=A   grey on black=B  black on red=C   grey on red=D

 

*Actual size of standard sized prints may vary depending on the proportions of the specific image.  Specify exact dimentions if Custom Sized.

 

 

Name                  Last                                                 First                                          M. I.

 

Mailing Address

City

State

Zip

 

 

 

 

Billing Address if Different

City

State

Zip

 

 

 

 

Home Phone:

 

Work Phone:

 

 

 

Payment Information

 

Check / Money Order

 

Credit Card

Visa/MC/Disc/AMEX

Card Number

Expiration Date

 

 

 

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