Box and Clock Fine Craft Gallery-Commission



Name______________________________________________________ Company___________________________________________________ Address____________________________________________________ City_________________________________State______Zip__________ e-mail______________________________________________________ Describe intended use or 'look' wanted: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Approximate s ize required / wanted _____________________________ Wood(s), or light dark, etc._____________________________________ ___________________________________________________________ Do you want special materials used in the box or clock such as gold leaf, brass, silver, glass, marble, etc.? ____________________________________________________________ ____________________________________________________________ Minimum design charge is 3 sketches for $50, providing you place a box order. A $100 charge if you don't end up placing an order. A $100 deposit is required on placement of a design request, $50 will be refunded when you place a box order. After picking a basic design, the charge for alterations is $50 for a set of 3 variations. ___________________________________________________________ All designs and © Copyright remain the property of Merlen Seslar and may not be reproduced in any form.
		Print this form and send to: Seslar Design 17607 Wesley Chapel Rd. Churubusco, IN 46723 Phone / Fax 260-693-9801 e-mail: merlen@boxandclockgallery.com
	Additional comments: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________