Name *

First Name

Last Name

Phone

(###)

###

####

Home Address

Needed for invoice and shipping purposes

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Terms and conditions *

By filling out this form I agree to paying the invoiced amount that has been communicated to me and understand that that amount is subject to change due to amount of work. I also understand that Artist is not responsible for the piece after shipping. Invoice will be sent upon review of request for order.

I agree