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Please print out this form and mail with check or money order to
Michael Barretta
478 E. ALTAMONTE DR. ,SUITE 108 PMB 314
ALTAMONTE SPRINGS, FL 32701-4622

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This Bust makes a wonderful addition to any  Home, Office, School, Public Building or Library.
GEORGE WASHINGTON SCULPTED BUST
Shipped to U.S. address
$149.99 plus $14.99 FEDEX shiping & packing  US adderss no PO Boxs Please
Total = $164.98
US Dollars make check or money order payable to Michael Barretta
 

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NAME ___________________________________________________________

ADDRESS ________________________________________________________

 CITY ____________________________ STATE ___________  ZIP _________
 

 Telephone Number ( ___ ) ___-____    ( ___ ) ___-____
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