"Golden Warrior" statue order form

Please print and send the form below with payment (check or money order for $85.00) -The price includes shipping by UPS 2nd Day Air- payable to: Jane Golden P.O. Box 676 Occidental, CA 95465 Alternately you can simply email your order request to: goldenjane@aol.com Please send the statue(s) to:

Name________________________________________ Address____________________________________________________________________________ ____________________________________________________________________________ City_________________________ State________ Zip__________________ Phone_________________________ Email_____________________________________ Finish/quantity__________________________________________________________________________ ________________________________________________________________________________________ Please indicate which finish(es) you have chosen and how many of each. - - - - - - - - - - - - - - -- - - - -- - - - - - - - - -- - - - - - - - - - - - - - - -- - - - -- - - - - - - - - -- - - - - - - - - - - - - - - -- - - - -- - - - - #GWbrz Bronze__ #GWgs Gold & Silver__ #GWp Pearl__ #GWs Stone__ #GWrw Radiant Wood__ #GWj Jade__ #GWbl Blonde__