Order Form

 VISA, MASTERCARD & DISCOVER Credit Cards & CHECKS Accepted
 Creation Energy Art Studio
 5401 Franklin Street
 Lincoln NE 68506
 Phone: 402-483-5308 Fax: 402-483-5930
 E- mail: creationenergy@windstream.net
 Web site: www.glendadietrich.com
 Checks may be made out to Creation Energy.

Print this page and mail or fax it along with your payment. Charge-card orders may also be E-mailed
Name:
Address:
City/State/Zip:
Phone: E-mail:
Credit Card: Circle One: Visa  MasterCard  Discover
Card #: Exp. Date:
Name on Card:

Ship Order to (if different from above):

 

 
Quantity/Size
Name of Item
Amount
     
     
     
     
 
Subtotal
  
 
NE Residents add Sales Tax
  
 
Shipping Cost (see item description)
  
 
Total
  
>biography                >artwork                >contact                >ordering                >home