SCULPTURE ORDER FORM
Name:_________________________________________________________________
Address_________________________________________City____________________________
State______________________________Country_________Zip/Postal Code________________
Phone number___________________________email address____________________________
Cocker on Book/Qty____________Variety______________
Puppy on Ball/Qty______________Variety_____________
Custom painting: Please describe or include photo of dog you would like to resemble. There is an
addition charge of $25.00 for custom painting.
________________________________________________________________________________
________________________________________________________________________________
Number of Statues ________X $100.00=_______________
Shipping - $12.00 per statue = ______________
Total Order ______________
Please send order form with check/money order made payable to ASCF, in US funds only, and mail to:
Julie Virosteck
VP-ASCF
4424 Vermont Road
Wellsville, KS 66092
