First Name      
Last Name	
Address		
City		
State/Province	
Zip/Postal Code  
Country         
Phone number    
E-mail          

Painting No		Qty 
Painting No		Qty 
Painting No		Qty 
Painting No		Qty 

Notes           

IMPORTANT: You can pay with your credit card    DINERS,
           but you must fill the payment order and fax it to (+30)286-071325