
| ORDERS FAX FORM Name : ............................................................................................. Mailing address (in full) : .................................................................... 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 : ........................................................................ ....................................................................................................... ....................................................................................................... ....................................................................................................... Place and date : ................................................................................. Signature : ....................................................................................... |