Sold To:	Name:
	Street Address:
	City, State, Zip:
	Telephone:
Ship To:	Name:
	Street Address:
	City, State, Zip
	Telephone:
Please Check Payment Method:
				Check		Money Order		C.O.D.
				(US Mail)		(US Mail)		(FAX)
Style#		Description					Unit Cost	Qty	Subtotal
1
2
3
4
5
6
7
8
9
10
16
17
								Subtotal
Please Fax C.O.D. Orders To:					CA Resident add 8.25%			Tax
Fax:  (734) 939-4260					Add $30 per Panel			S & H
								Total
Please Send Payment To:
West Coast Gallery
4113 Nipomo Avenue
Lakewood, CA 90713