SILESIAGALLERY

REGULAR PAYMENT:
PLEASE FILL OUT AND SEND WITH PAYMENT TO :

SILESIA GROUP INC.,  P.O. BOX 15823, CLEARWATER, FL 33766-5823, USA
YOUR NAME.......................................................................................................
ADDRESS............................................................................................................
ADDRESS 2.........................................................................................................
CITY.........................................STATE...................ZIP CODE............................
PHONE NO...................FAX NO...........................EMAIL...................................

NAME OF THE ART WORK................................................................................
PRICE..................................................................................................................
DESCRIPTION OF THE ART WORK...................................................................
............................................................................................................................

ADDITIONAL COMMENTS..................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
DELIVERY TIME MAY TAKE OVER 4 WEEKS