To commission artwork, simply print this page, fill in this form, and send it in to the Flying Goose Gallery.  (The Address is on the bottom of the page.)

Your Name: ________________________________________________________

Your Address: ______________________________________________________

City: _________________________________State: ______Zip: _________

Phone: __________________   Number Of Pictures enclosed : _________ 

E-mail Address:____________________________________________

                                                (Returned with artwork.)

Any special instructions or ideas?

________________________________________________________

________________________________________________________

________________________________________________________

Refundable $50 deposit.
o Check (made out to the Flying Goose) 

o MC   o Visa

Credit Card Number:   _   _   _   _  /  _   _   _   _  /  _   _   _   _  /  _   _   _   _

Expiration Date:  ___ /  ___

Signature:__________________________________________

(Please include your e mail address above.  I'll send you notification informing you that I've received your Commissioned Artwork Submission the day I receive it.)

Contact Information

John Mets
5308 Rt. 353
Little Valley, NY  14755
716-938-6814

e-mail: john@flyinggoosegallery.com

Copyright © 2006 The Flying Goose Gallery
Last modified: August 11, 2008