Ralph Proctor Gallery Slide Sets Order Form
Print this form, complete the order information, and mail to the address below.
You may fax your credit card order to: 1-412-731-8542
Quantity Item Price Each* Total Amount
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[______] Slide Set 1: Sande Secret Society Masks $100. ____________
[______] Slide Set 2: Ashanti and Fanti Fertility Symbols $100. ____________
[______] Slide Set 3: Dan Masks $100. ____________
[______] Slide Set 4: Art of the Yoruba $100. ____________
[______] Slide Set 5: African Metal Work $100. ____________
[______] Slide Set 6: West African Beadwork $100. ____________
[______] Slide Set 7: Introduction to African Art $100. ____________
[______] Slide Set 8: The Female Form in African Art $100. ____________
[______] Slide Set 9: Dahomey Applique Cloths $100. ____________
[______] Slide Set 10: African Masking Traditions $100. ____________
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SUBTOTAL ____________
PA residents add 6% of SUBTOTAL sales tax ____________
Allegheny County residents add 1% or SUBTOTAL sales tax ____________
*all prices INCLUDE U.S. shipping and handling TOTAL ____________
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PURCHASER INFORMATION
Name_____________________________________ Phone ( ) _____________________
Address____________________________________________________
____________________________________________________
City________________________ State__________ ZipCode/Country____________________
E-mail Address__________________________________________________________________
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CREDIT CARD: [ ] VISA [ ] MasterCard [ ] American Express
Cardholder Name_________________________________________________________________
Account Number__________________________________ Expiration Date________________
Cardholder Signature____________________________________________________________
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Make check or money order payable to Ralph Proctor Gallery
and mail to 322 North Lang Avenue
Pittsburgh, PA 15208
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Thank you for your order!