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Mail Order Form
Please print this form, fill out and include with check payable to:
Patsy P. Ramsey Ovarian Cancer Foundation.
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Mail to: Patsy P. Ramsey Ovarian Cancer Foundation
C/O Robert B. Hoffman
Certified Public Accountants
108 Michigan Avenue
Charlevoix, Michigan 49720
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Name:_________________________________________________________Phone Number (_____)_____________
Address:____________________________________________City:_______________State:________Zip:_________
GICLEES Title of Print:_______________________________________________Size:__________________
(Circle One) Price:________________
Canvass OR Watercolor Paper
Plus Shipping (each): $30.00
Tax: (MI & GA only)____________
Total:_____________
Title:______________________________________Quantity:____ X Price: $25.00 = ___________
NOTECARDS Title:______________________________________Quantity:____ X Price: $25.00 = ___________
Title:______________________________________Quantity:____ X Price: $25.00 = ___________
Plus Shipping : $2.00
Tax: (MI & GA only)____________
Total:_____________
NOW ACCEPTING VISA AND MASTERCARD
Check One: VISA____ Mastercard____ V CODE (3 digit code on back of card)__________
Name on Card:_____________________________________________________
Credit Card Billing Address if Different:________________________________________________________________
Card Number:______________________ Expiration Date:___________ Total:________________
By signing below, I hereby authorize the Patsy P. Ramsey Ovarian Cancer Foundation
to charge the credit card listed above for the purchase of the above noted prints/notecards.
Signature:_____________________________ Print Name:______________________________ Date:____________
Please Note: Robert B. Hoffman, Certified Public Accountants will appear on your statement.
If you would like more than one of Patsy's "prints", please print multiple copies of this form and fill out separately but
mail together with one check or credit card payment. Multiple sets of notecards can be ordered on one form.
Thank you for your support! Each print is numbered and has a certified document of authentication signed by John,
registering you as the owner with the foundation. If you have any questions, please email us.
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