ORDER form

Readers using Netscape 1.0 or above are strongly advised to use the secure version of this form.




Name of Painting: Name of Artist: Cost: Check this box, if you would like to receive a quote via e-mail for delivery cost. No funds will be debited to your card until agreement on delivery details has been established. If this box is not checked please email us with a date and time for us to have the painting ready for collection from our London offices.

WARNING: THIS IS NOT A SECURE SERVER.. If you are concerned about your card security please submit your order without card details and we will confirm the card via telephone. Please put your phone number and name in the cardholder address fields. Alternatively for payment by cheque or Bankers draft, please fill in the address details and email address with a comment to that effect, and we will reserve your painting and await payment. 
Type of Credit Card:    Access  Visa  Other               Expiry Date 

      Card Number:
Cardholder's Details 
             Name: 
          Address: 
                   
      Town/Suburb: 
     County/State: 
          Country: 
    Post Code/Zip: 

Telephone Number :  (optional)

          E-mail :
Delivery Details (if different) 
         
          Address: 
                   
      Town/Suburb: 
     County/State: 
          Country: 
    Post Code/Zip:

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