Print this form on your printer complete it and send it along with your
deposit to:
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Pet Portraits by
Colleen Rowan Kosinski
807 Kings Highway South
Cherry Hill New Jersey 08034
856-857-1850
Your Name ________________________________________
Email Address ________________________________________
Pet''s Name ________________________________________
Daytime Telephone # (_____)_______-________
Evening Telephone # (_____)_______-________
Shipping Address ________________________________________
________________________________________
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Description of ________________________________________
Your Pet ________________________________________
________________________________________
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Breed or ________________________________________
Mix of Breeds
Eye Color ________________________________________
Indicate which photo(s) best represent the eye color
Medium pastel ___ | oil ___
(Please check one)
Size ____ inches X _____ inches
width height
Type of Portrait head only ___ | full body ___ | full body & custom background ____
(Please check one)
Is this a yes ___ | no ___
surprise gift? (Please check one)
If this is a gift ________________________________________
what is the required delivery date?
Addition Comments ________________________________________
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