Thank
you for choosing Paradise Giclee. For your convenience,
fill out the Form below, Print it, and then Fax
or Mail this form in its' entirety for us to process
your order.
Ordered
By
First Name:
Last
Name:
Address
1:
Address
2:
City:
State:
Zip
Code:
Country:
Day
Phone:
Night
Phone:
Cell
Phone:
Fax:
Email:
Web
Page:
Sales
Tax Resale #
Ship
To (If different address than above)
First Name:
Last
Name:
Address
1:
Address
2:
City:
State:
Zip
Code:
Country:
Day
Phone:
Night
Phone:
Cell
Phone:
Fax:
Email:
Web
Page:
Sales
Tax Resale #
Original
Work Of Art Details
Title:
Original
Art Media:
If
Other:
Image
Size :
Media
Delivered:
If
Other:
Image
Size :
Desired
Output Details
Choose:
Paper
Canvas
If
Other:
Desired
Size: Paper* or Canvas**
Your
Edition Size:
Insurance
Value required for Shipping
(Insurance
cost to be paid by Artist or Agent)
Pricing
Program Desired
Quantity Prices (Required Deposit See Below)
Single Piece Pricing (Full Payment Required
See Below)
Deposit/Payment
Required
Enclose Deposit Check or Credit Card Info:
VISA
MC
AMERICAN EXPRESS
Account Number:
Expiration Date:
-
-
CC Billing Address If Different From Above
Authorized
Charge Amount:
Date:
This
signature authorizes Paradise Giclee to reproduce
the art described as specified herein.