Countryside Orderform

	COUNTRYSIDE COLLECTION 2 - ORDER FORM Simply print this page, than place your order by telephone, fax or post Minimum total order £15.00 excluding postage.

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Description	Mounted Print £10.50	Framed Print £16.50	Total Price
Serious Talk			Ł
GallowayTwins			Ł
Down by the River			Ł
Eagle Eye			Ł
Proud Parent			Ł
Hedgehog			Ł
Woodpecking			Ł
Kingfisher Blue			Ł
Highlander			Ł
Unconditional Love			Ł
Special Delivery			Ł
Swan Lake			Ł
Butterfly Wings			Ł
It's a Foxes Life			Ł

Buy any two framed prints for £30.00
Buy any two mounted prints for £18.00


	Postage and Packing: Please add Ł6.50 for orders to be delivered within the U.K., Channel Islands/Eire, Europe, USA/Canada, Japan & Rest of World please e-mail for price.

Postage & Packing	Ł

Total Due	Ł

Payment Options:


	¨


	I enclose a Cheque / Postal Order for Ł ___________ made payable to “Rockey” ( In UK Sterling only )


	¨


	Please debit Ł ___________ from my credit card account:


	¨

Delta


	¨

Diners Int


	¨

Mastercard


	¨

Switch


	¨

JCB


	¨

Visa


	Card Number:


	__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __


	Issue Number: __ __

Expiry Date: __ __

			Switch Only

	Valid From: __ __


	Name on Card: _____________________________


	Signature: _____________________________

Card Holders Details:


	Title:______ Initials:______ Surname:_________________________ Address:_____________________________________________________________________________________ Postcode:______________ Daytime Telephone Number:__________________________________________


	*Please note: each item is prepared individually, so please allow 28 days for delivery


	Post to:


	The Art of Leslie Rockey, 35 Dacre Road, Herstmonceux, East Sussex, BN27 4LP, England, U.K.


	Fax to:


	+44 (0) 1323 831550