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Request/Order Form
Call 564-232-6099
if you have any questions
The artist will contact you to discuss your request/order before processin
g.
Items marked with
*
are required fields
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Print #
Print Size Desired
11"x14"
16"x20"
16"x24"
16"x32"
20"x30"
24"x36"
Larger
Printed on...
Acrylic
Canvas
Other
Other
Please provide any details about your order
0/400 characters
First Name
*
Last Name
*
Email
*
Phone
*
Shipping Address
City
State
Zip Code
Name on Card
Credit Card Type
Visa
MasterCard
American Express
Discover
Credit Card Number
Expiration Date (mm/yy)
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