Canadian Customers: Please use this form to purchase and ship to Canada original artwork by Jacques Pepin. We will then contact you via phone or email (choose below) with the order total (including shipping) and to obtain your credit card number. All fields are required.

Name *

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Last

Email *

Phone *

Please contact me via (please check one): *

• Phone
• Email
• Either

Name of Original Artwork (Required) *

Address *

City *

Province *Please Choose a ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

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To help with security please answer this math problem: *

Which is larger: 10 or 5?

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