THE OFFICIAL DICK WARLOCK WEBSITE << http://www.dickwarlock.com >> ***PLEASE PRINT FOR YOUR ORDER*** PLEASE FILL OUT THIS FORM IN ITS ENTIRETY. PLEASE ALSO PROVIDE YOUR E-MAIL ADDRESS IN CASE THERE IS A QUESTION REGARDING YOUR ORDER. IF YOU DO HAVE ANY QUESTIONS, PLEASE E-MAIL DICK@DICKWARLOCK.COM ****PLEASE READ CAREFULLY**** 1. All orders (USA and/or Foreign) to be accompanied with postage paid envelope or proper container. 2. Items sent without proper postage and return envelope or container WILL NOT BE RETURNED! 3. Expect a 4 to 6 week turn around time. 4. Cashiers Checks and Money Orders in US Currency Only. Regretfully, Personal Checks Are Not Accepted. ********************** Name:________________________________________________ Address:___________________________________________________________ City:_________________________________ State: _______Zip:_____________ Your e-mail address: _______________________________________ ********************** Photo # Description Quantity Cost 1 "Dick & Chucky" [ ] $ 20.00 **Sold Out** "The Shape- color" [ ] $ 20.00 3 "The Shape- Hallway" [ ] $ 20.00 **Sold Out**"The Shape- Knife" [ ] $ 20.00 **Sold Out** "Tawney & Dick" [ ] $ 20.00 6 "Jamie & Dick" [ ] $ 20.00 7 "John & Dick" [ ] $ 20.00 8 "John & Dick" (camera) [ ] $ 20.00 9 "Licking Knife" [ ] $ 20.00 10 "Jamie & Dick" (hospital) [ ] $ 20.00 11 "Dick kissing Jamie" [ ] $ 20.00 **Sold Out** "Jason & Michael" [ ] $ 20.00 13 "Autographed Envelopes" [ ] $ 40.00 14 "The Shape - Stairs" [ ] $ 20.00 15 "Personal Items" [ ] $ 20.00 Forgein Orders Add $ 5.00 TOTAL $ _________ Your comments, special requests, and whom to personalize to: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________