ISMAIL HYATT
ORDER FORM
A Personal
Detail
1.
Full Name (CAPITAL LETTER) : ………………………………………..................... 2.
Address (CAPITAL LETTER) : …………………………………………………………………..
…………………………………………………………………..
………………………………………………………………….. 3.
Phone Number : ………………………………………………… 4.
E-mail Address : ……………………………………………….. 5.
Occupation : ……………………………………………………… B Order
Detail
6.
Portrait Medium : (
) Soft Pastel ( ) Oil Color
( ) Pencil 7.
Portrait Size : (
) 50 x 75 cm (
) 36 x 55 cm 8.
Portrait Detail : __________________________________________ ________________________________________________________ ________________________________________________________ C Payment
Detail
9.
Type of payment : CHEQUE / CASH / MONEY
ORDER / POSTAL ORDER 10.
Total payment : USD/RM ………………………………. 11.
Cheque/Money Order/Postal Order Number :
…………………………….. Please make sure to enclose
the payment and the photo, then simply send
it to Ismail Bin Hussin, No. 4, Lorong Kubang Buaya 46, 25250 Kuantan,
Pahang Darul Makmur, Malaysia. Date : ……………………………. ……………………………………………. ( Your Signature Here ) |