Vincent Di Fate, Illustrator
P.O. Box 1771
Wappingers Falls, New York 12590-1771

The Science Fiction Art of Vincent Di Fate autographed copy order form.
Please print the requested information legibly.

NAME : _________________________________________________________

ADDRESS : ______________________________________________________

CITY : _________________________________________________________

STATE : ________________________________________________________

ZIP CODE : _____________________________________________________

E-MAIL ADDRESS : _______________________________________________

PHONE NUMBER : _________________________________________________

AUTOGRAPH ONLY : ______
(Please check here if you desire an autograph only)

INSCRIBE TO : ______________________________________________

____________________________________________________________
(Please include the name[s] to whom you'd like the book inscribed)

Please send me __________ copes of The Science Fiction Art of Vincent Di Fate

@ $29.95 each = _____________________________________
(For foreign orders, please remit by money order payable in US funds)

For shipping and insurance, please add $6.00 per book @ __________
(For orders outside the U.S., please remit by money order only, payable in U.S. funds)

New York State residents, please add NYS Sales Tax : ______________________________

TOTAL ENCLOSED : _______________________________________________
(Please allow four to six weeks for delivery)

Mail your payment and order form to:
Vincent Di Fate - Illustrator
P.O. Box 1771
Wappingers Falls, New York 12590-1771