-----------   Order form - please make a check payable to Reiko Hervin   ------------
Clip this portion with a check, please send to :  Reiko Hervin 11 Norton Lane, Wellington, NV 89444

Name: Please print                                                  Phone:                                

Address:                                                                                                        

E-mail address:                                                                                             

Splash 9: Special offer: $23.50 a book. Id like to order                    book(s).

If you want your book mailed to you, please enclose $3.50 for postage for each book.

Im including my check (or money order) total of $                       .
*Please allow 1-2 weeks for delivery.  You will be contacted by e-mail when your book is available to pick up at the East Fork Gallery. Thank you very much for your order!

Please sign below when you pick up your book at the East Fork Gallery.

Signature:                                                           Date:                          

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