Buy this painting

Postal Purchase form.

I would like to buy this painting.
Please find enclosed Bank Draft \ Money Order
drawn in US Dollars to the amount of $ 1,300

Title
Medium
Size
Price (Un-Framed)

My contact details are

Name

Surname

Tel No

Please send my painting to

Name if different from above

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Address

City

Post/ Zip Code

State

US only

Country