ORDER FORM
Bizzart Image
FAX: (514) 457-9243
E-MAIL: sales@bizzart.com

Note: Sending this will reserve your Limited Edition
Print for up to two (2) weeks until your check or money
order arrives by mail. Please see this URL for more information.
Bizzart Image: http://www.bizzart.com/pitts.html

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|-------------------------------|----------|------|
|                               | QUANTITY | COST |
|-------------------------------|----------|------|
|           ARTIST SIGNED PRINT |          |      |
|-------------------------------|----------|------|
|       PACKAGE CO-SIGNED PRINT |          |      |
|------------------------------------------|------|
|                                SUB TOTAL |      |
|------------------------------------------|------|
|                       POSTAGE & HANDLING |      |
|------------------------------------------|------|
|           CANADIAN RESIDENTS ONLY GST 5% |      |
|------------------------------------------|------|
|         QUEBEC RESIDENTS ONLY PST 9.975% |      |
|------------------------------------------|------|
|                                    TOTAL |      |
|------------------------------------------|------|


NAME: _____________________________________________

ADDRESS: __________________________________________

STATE / PROVINCE: _________________________________

ZIP / POSTAL CODE: ________________________________

COUNTRY: __________________________________________

TELEPHONE NUMBER: ____ (    ) ______________________

COMPANY TAX NUMBER or PERSONAL SOCIAL SECURITY NUMBER:*

_____________________________________________________

*(without this information, we will not be able to ship
to the USA)


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FAX TO: (514) 457-9243

E-MAIL TO: sales@bizzart.com

MAIL TO: 22 Sunny Acres
         Baie D'Urf 
         Quebec, Canada
         H9X 3B6