Kanda's Gallery B.O.Q.

Within Japan:  FAX (042)553-4041  PHONE (042)552-5431
From USA:  FAX (011)81-425-53-4041  PHONE (011)81-425-52-5431

In order to process your order faster. Please email us with the print request before
mailing a fax order. We will be able to verify the availability. Thank you.

Order Form

Date_________________________________________________________________

Name________________________________________________________________

Address______________________________________________________________

City________________________________________State___________Zip________

Shipping Address         Name______________________________________________

(If different from above) Address___________________________________________

                   City________________________________State_________Zip_________

Daytime Telephone Number (           )________________________________________

Email address__________________________________________________________

Charge to my MasterCard  [     ]  Visa [     ]
American Express [     ] Must also have four digit number located on front of the card to process
AMEX sales. (This number will not be embossed) [     ] [     ] [     ] [     ]

(We can not except Debit Cards)

Card Number______________________________Exp. Date____________________

Signature:_____________________________________________________________
Artist Name Title Price
. . .
. . .
. . .
. . .
. . Sub-Total
. . Shipping
. . Grand Total