ORDER FORM (Please use one order form for each order)

Mail your order to: Mobile : +66 81 9116907 , +66 81 9117824

Miss Benyapha Prasertwetmon Office hours : 9.00 am. – 9.00 pm. (Thai time)

9/86 moo.6 Phuket Golden Ville2                                            7 days a week

Vichitsongkram Rd.

Kathu, Phuket 83120 Thailand

To commission your portrait painting, please print out and fill in this order form and send it

with your photograph(s) by registered airmail.

Ordered By : (Use black and blue ink when faxing your order)

Date : _________________________________

Name : [ ] Mr. [ ] Miss [ ] Mrs._______________________________________________

Address : __________________________________________________________________

City : _______________________________ State : ________________________________

Country : _________________________________Zip/Post Code : _____________________

Daytime Phone [__________] ____________________ E-mail :________________________

Please paint a portrait painting from the enclosed photograph(s) on the size checked below :

[ ] Pastel painting Size : [ ] 10”x 14” [ ] 14”x 20” [ ] 20”x 28”

[ ] Back/White    Size : [ ] 10”x 14” [ ] 14”x 20” [ ] 20”x 28”

[ ] Oil painting Size : [ ] 16”x 20” [ ] 18”x 24” [ ] 20”x 28” [ ] 24”x 32”

[ ] 1 figure [ ] 2 figures [ ] 3 figures [ ] ____ figures

Please confirm eye color and hair color : ____________________________________________

Special instruction (requirement) : _________________________________________________

Thank you - Mr. Sangsri

Benyapha Prasirtvetmon (management)