Jozef Stefanka "Trencin"
                  LIGHT SCULPTURE
Please Print        ORDER FORM               
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Title___ First Name___________ Last Name___________________

Organization Name(if applicable)___________________________

Tel______________ Fax______________ email__________________

Address____________________________________________________

________________Post/Zip_________Country___________________

Delivery Address (if different)____________________________

___________________________________________Post/Zip________
DETAILS OF WORK:
Art Number orWork Title                     Purchase Price
          
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___________________________________________________________

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                              Sub-Total  CDN $_____________

                             *Shipping Costs $_____________

                         GST if in Canada 7% $_____________

	 Quebec Sales Tax (if applicable) 8% $_____________   

                              ORDER TOTAL    $_____________

* It is our policy to charge the exact cost of
  shipping. If you have not received a quotation, 
  please do not complete the Shipping Costs or Total 
  figures.  We will notify you of this cost before 
  proceeding with the order. Please allow up to 45
  days for delivery.

I enclose my certified cheque made out to
Jozef Stefanka for the sum of CDN  $__________.

I accept Terms and Conditions of Sale and wish 
to order the Works detailed above.

Signed __________________________  Date _____________

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VOICE:         +1 418 774 2971
FAX:           +1 418 774 6485

MAIL:          Jozef Stefanka
               C.P. 215 
               Beauceville, Quebec	   THANK YOU FOR YOUR ORDER
               Canada		           http://www.slovak.com/trencin 
	       G0S 1A0