| To
commission a portrait, please print out the form and send it with
your photograph and payment to the address below.
Name: _________________________________________________________ Address: ________________________________________________________ City: _______________________ State:
_______________________________ Country: _____________________ Zip/Post Code:_______________________ Tel: _________________________ E-mail:_____________________________ Please paint an [ ] 32x46cm [ ] 35x50cm [ ] 40x60cm [ ] 50x70cm [ ] 60x80cm [ ] 60x90cm [ ] 70x100cm [ ] Other ____ x ____ Paint background: [ ] Plain [ ] As in Photograph [ ] Other State any special requirements for your portrait. (Please confirm
colour of subject(s) eyes). ________________________________________________________________ ________________________________________________________________ I enclose payment of ___________ as payment for my portrait. |
