APPLICATION FORM

Name ____________________________________________________

Address __________________________________________________

_________________________________________________________

Phone (_____) _____________ E-Mail _________________________

Portrait name ______________________________________________

The Size of Portrait desired: 16” x 20”________ or 18” x 24”________

Delivery format: CD______ Unstretched_______ Stretched__________

Type of Payment: Check_____ Money Order_____ PayPal___________
(No payment required until you approve a partial painting)

Comments_________________________________________________

__________________________________________________________

__________________________________________________________
Remember to include your non-returnable and non-copyrighted
photograph with your submission. You will be contacted by e-mail.

Submitted pursuant to the terms outlined in the Portraits by Computer website