Please fill in information for each painting you wish to buy if buying more than one.

PAYMENT can be made via Bank Cheque (no personal cheques please) or Money Order. (Email me if using Direct Bank Deposit.)

YOUR NAME (capitals):____________________________________

ADDRESS:

_________________________________________

_________________________________________

_________________________________________

NAME OF PAINTING(S) (capitals):

1. _________________________________________

2. _________________________________________

3. _________________________________________

4. _________________________________________

5. _________________________________________

6. _________________________________________

Please print this page and enclose Bank Cheque or Money Order payable to "Hillie Dyke". Please email me for address details to post this form. (I have street address only so this is a precaution to keep my personal details private.) Thank you.

Your painting(s) will be professionally wrapped and on their way immediately upon receipt of this form and will take approximately one to two weeks for delivery.