Submission Form

First Name:                ………………………………………………………..

Last Name:                 ………………………………………………………..

Country:                     ………………………………………………………..

Address:                     ………………………………………………………..

                                    ………………………………………………………..

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Telephone:                 ………………………………………………………..

Email:                         ………………………………………………………..

TITLE:                        ………………………………………………………..

Dimensions:               ………………………………………………………..

Year Completed:        ………………………………………………………..

Price:                          ………………………………………………………..

In case of a sale there is a commission of 20%

Date:                           ………………………………………………………..

Signature:                   ………………………………………………………..