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I enclose a check for____________
I have read and agree to all conditions stated in the prospectus.
_____________________________________
Signature
of Artist
(please photocopy form for multiple entries)
Credit Card Information
(please note the Gallery can only accept Visa/ MasterCard)
Credit Card #
____ ____ ____ ____
expiration date
___/___
Name as it appears on card:
_____________________________
Billing Address:
__________________________________
__________________________________
___________________________________
Telephone #
___________________________________
Signature of card holder:
_____________________________________________
Make sure to put all information down, this form will be separated from the entry form.
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