Regime Imperia | Order Form

Order Form

Name:
Email:
Street Address:
City
State
Zip Code
Country:
I am at least 21 years old:	Yes No
My order is as follows:	Pic 001 Pic 002 Pic 003 Pic 004 Pic 005 Pic 006 Pic 007 Pic 008 Pic 009 Pic 010 Pic 011 Pic 012 Pic 013 Pic 014 Pic 015 Pic 016 Pic 017 Pic 018 Pic 019 Pic 020	Pic 021 Pic 022 Pic 023 Pic 024 Pic 025 Pic 026 Pic 027 Pic 028 Pic 029 Pic 030 Pic 031 Pic 032 Pic 033 Pic 034 Pic 035 Pic 036 Pic 037 Pic 038 Pic 039 Pic 040	Pic 041 Pic 042 Pic 043 Pic 044 Pic 045 Pic 046 Pic 047 Pic 048 Pic 049 Pic 050 Pic 051 Pic 052 Pic 053 Pic 054 Pic 055 Pic 056 Pic 057 Pic 058 Pic 059 Pic 060	Pic 061 Pic 062 Pic 063 Pic 064 Pic 065 Pic 066 Pic 067 Pic 068 Pic 069 Pic 070 Pic 071 Pic 072 Pic 073 Pic 074 Pic 075 Pic 076 Pic 077 Pic 078 Pic 079 Pic 080	Pic 081 Pic 082 Pic 083 Pic 084 Pic 085 Pic 086 Pic 087 Pic 088 Pic 089 Pic 090 Pic 091 Pic 092 Pic 093 Pic 094 Pic 095 Pic 096 Pic 097 Pic 098 Pic 099 Pic 100
PLEASE REMEMBER: Mailing charges within the United States are: 1 to 20 Prints….$4.00 21 to 40 prints….$8.00 41 to 60 prints…. $12.00 FOR ANY ORDERS OVER 60 PRINTS, CONTACT EDITORS AT REGIME IMPERIA EACH ART PRINT IS ONLY $2 After sending us your order, please remember to pay via Check or Money Order to: Regime Imperia P.O. Box 1436 Murray Hill Station New York, NY 10156
General Comments:	Notes and comments here