ORDERS FAX FORM


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Telephone (home) : ...........................................................................


Telephone (business) : .......................................................................
please include country and area codes


Fax number : ...................................................................................


Name of the artist : ...........................................................................
who you wish us to reproduce


Title of the painting : .........................................................................
you want to have reproduced


Height : ............................. Width : .............................
Size in centimetres that you want your painting


Special requirments : ........................................................................

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Place and date : .................................................................................



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Fax this to +66 77 230497