Poetry
Order Form

Please print this page, fill it out and mail it in along with your payment.


"unrestrained madness" was published in a limited signed edition of 115.
"frozen rainbows" was published in a limited edition of 200.

A few copies of each are still available.



Name:

Address:

City:

State/Province:

ZIP/Postal Code:

Phone:

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

_______________________ Country:________________________

_______________________ E-mail:_________________________

Selection Qty Price Total
unrestrained madness # $12 $
frozen rainbows # $10 $
Order Total $
California residents add 9.75% sales tax $
Shipping & Handling
Domestic: $3/1st Item, $1/Each Add'l
International: $7/1st Item, $2/Each Add'l
$
Total Enclosed $

Make checks or money orders payable in $US to Leonard Ellis.
Send your order along with payment to:

Leonard Ellis Productions
Post Office Box 66002
Los Angeles, CA 90066
U.S.A.

Please allow four to six weeks for delivery.