Order Form
To order, print this form, fill in the required information and mail to:
Martin De Leon
915-C West Foothill Blvd. #212
Claremont, CA 91711
Please make checks or money order payable to: Martin De Leon

Name:

Address:

City:

State:

Zip:

Tiempo de Madurez

CD

$18

QTY

Entretangos y Canciones

CD

$18

QTY

Timeless Tango

CD

$18

QTY

Adios Nonino - Acrilico en Canvas 24"x36"

Painting

QTY

Astor - Acrilico en Canvas 24"x36"

Painting

QTY

Fueye - Acrilico en Canvas 48"x36"

Painting

QTY

El Gordo Triste - Acrilico en Canvas 24"x36"

Painting

QTY

Grand Total

$

Check Number_____________________________________
Bank Name________________________________________
For questions regarding your order please call 951.204.1036
Keep a copy for your records.
Thank you!