ORDER FORM -- Encounter with Duchamp

Please print out, fill in and mail with cash check or money order (U.S. funds)
PAYABLE TO TIM KUMMEROW to:

Fresh Widow 3000
129 East Colorado Boulevard, # 536
Monrovia, CA 91016

Please allow 3-6 weeks to receive your order.

Please send notification of your order to
tim@val.net with the subject ORDER RECORD. 

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 NUMBER OF COPIES _________ X $10.00 EACH 
 
 (cost includes shipping/handling)     TOTAL ENCLOSED $ _________ 
 
 NAME ___________________________________________________________________

 ADDRESS ________________________________________________________________

 CITY, STATE, ZIP _______________________________________________________
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