Gem Mint, Inc.

Information Sheet and Order Form


Product: Limited-Edition Lithograph

Total Number Produced: 1,992

Title: "Shaquille O'Neal - Center of Attention"

Artist: Mr. Kim Fujiwara

Autographs: All numbered and signed by artist; 1st 1,500 signed by Shaquille.

Shipping: All lithographs (17 1/2" x 24") are shipped in an individual tube via UPS, and are accompanied by a Certificate of Authenticity.


TO ORDER:

Please print out this form, then complete and return it to the address indicated below. Note: Orders are processed on a "first-come, first-served" basis.


Item (Limit 5 per customer).........................*Price.......Qty..................Total

Autographed by Shaquille ................................. $165 x ______ = $ _____________

Without Shaquille Autograph................................$ 65 x ______ = $ _____________

Total........................................................................................... = $ _____________

(MI residents add 4% Sales Tax) ................................................ + $ _____________

TOTAL AMOUNT DUE: ............................................................. $ _____________

- Price includes Postage & Handling in Continental U.S.
- Please allow 2 to 4 weeks for delivery.
- *Volume discounts available.

METHOD OF PAYMENT:

Check Money Order Other: _________________________

VISA MASTERCARD #_________________________________

Ex. Date:_______________

Name:
________________________________________________________________

Address (no P.O. boxes please):
________________________________________________________________

City: __________________________________ State: _____ Zip: ____________

Phone: (______)_________________________

Order Option: In the event GMI sells out of the Shaquille autographed litho, please substitute the non-autographed version, and return the price difference to me. Indicate option selected:

YES (substitute) NO (return my payment)

Signature:________________________________________________________

Date:_________________


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