Poetry
Order Form

Please print this page, fill it out and mail it in along with your payment.

"unrestrained madness" was published in a limited signed edition of 115.
"frozen rainbows" was published in a limited edition of 200.

A few copies of each are still available.

Name:

Address:

City:

State/Province:

ZIP/Postal Code:

Phone:

________________________________________________________

_______________________ Country:________________________

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Selection	Qty	Price	Total
unrestrained madness	#	$12	$
frozen rainbows	#	$10	$
Order Total			$
California residents add 9.75% sales tax			$
Shipping & Handling Domestic: $3/1st Item, $1/Each Add'l International: $7/1st Item, $2/Each Add'l			$
Total Enclosed			$

Make checks or money orders payable in $US to Leonard Ellis.
Send your order along with payment to:

Leonard Ellis Productions
Post Office Box 66002
Los Angeles, CA 90066
U.S.A.

Please allow four to six weeks for delivery.

PoetryOrder Form