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FIELDS MARKED WITH * ARE REQUIRED!

Billing Address
Shipping Address
(if different from billing)
First Name:*

 Last Name:*

 Street Address:*

 City:*

 Sate:*

 Zip:*

 		First Name:

 Last Name:

 Street Address:

 City:

 Sate:

 Zip:

Contact Info
(In the event I need to contact you, please complete as much as you can in this section.)

 Phone:

 Alternate Phone:

 Fax:

 E-Mail Address:*


Which Size Would You Like?:*
11x14

$195 $125
16x20

$295 $225
20x24

$395 $325
24x30

$495 $425
Please Contact Artist To Discuss Custom Sizes And Pricing.


How Many Pets Would You Like In The Painting?:*
One (No Charge)
Two (Addition $100)
Three (Additional $200)
Pets Name(s):


Which Style Would You Like?:*
STYLE PAGE
ORIGINAL
VAN GOGH
WHIMSICAL
POP ART


Would You Like A Custom Background?* (Additional $75):NoYes
From Photo:
Other:
Please Describe:


How Will Your Pets Photos Be Sent?*
MAIL
UPLOAD VIA PETARTBYANNA.COM
EMAIL
How Many Photos Will You Be Sending?
If Sending Photos By Mail Would You Like Photos Returned? YesNo


The Painting Should Feature?*
Face / Partial Body: (No Charge)
Full Body: (Additional $50)


How did hear about us:

Comments / Special Instructions:


Extra add-ons will be added when the balance is due.
Shipping Fee: (Added in PayPal checkout when paying final balance)

(PROMO: Free Ground Shipping)
UPS 2nd Day Air $28.00
UPS Ground $22.00 (Free)

Insurance coverage available for an additional $5.00


I have read the Frequently Asked Questions (FAQ) section and acknowledge how the terms and conditions apply to my purchase.* Yes

or



If you are uncomfortable sending this form over the internet, please print out a copy of this form or copy the outline as shown above and after completing the information, mail along with your photographs and down payment check to:

(PAYABLE TO ANNA AGSTEN)

Mail To:

PetArtByAnna.com
11124 NE Halsey
Studio #646
Portland, OR 97220



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