First & Last Name: _______________________________________________________________

Address: ______________________________________________________________________
                ______________________________________________________________________
City: ___________________________________________________________________________
Province/State: ___________________________________________________________________
Country: ____________________________
Postal Code: ________________

Phone Number: ( ________)__________________________________

Payment Options:

Cost of each book is $35.00 (Canadian), plus 7% Tax =$2.45, plus $3.00 for shipping =$40.45. For sales to the US, use a credit card which will do the conversion.

Money Order
Visa          MasterCard        Cheque                

Credit Card Number: _____________________________Expiry_________________

By e-mail: wppotter@kos.net   Phone 1-613-386-3400

Or Mail to: Diane Creber, Wilton Pottery, 239 Simmons Road, RR 2, Odessa, Ontario, K0H 2H0, Canada