To place an order print out this form or call Brandon Sura at (715)533-1106

E-mail to: suragallery@yahoo.com

Make checks payable to Brandon Sura and mail to:

Brandon Sura

23841 Adams St.

Indepedence WI, 54747

 

Quantitiy Item Description   Price Total
         
         
         
         
         
         
         
         
         
     
Subtotal
 
     
Shipping
15.00
   
5.5% Sales Tax
Tax
 
     
Total
 

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City___________________State_____Zip_________

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