Buy INX Art

Your Name

Title:

Publication:

Publication Type:

Circulation:

Billing Address:

City:

Planned Use of Artwork:

State:

Zip Code:

Office Phone: (Numbers only)

E-mail Address:

Country:

Fax: (Numbers only)

Multiple Use:

Please fill in all fields below:
Username (use your e-mail address):
Password :
Re-Type:

Item A	Image Title	Cost:

Item B	Image Title	Cost:

Item C	Image Title	Cost:

Item D	Image Title	Cost:

Item E	Image Title	Cost:


	Total:

Jot down the username and password you've chosen. Hit SUBMIT to enter your
order and receive further instructions. All Sales are final.
Thank You for Ordering from INX!