Black ink splatters and ink dust spread across a white background in a pattern.

THANK YOU
for your adding a piece of my art to your collection

Receive your Certificate of Authenticity for original artworks and more information about your piece.

Title of artwork

Please indicate title and or description of artwork

Catalogue Number

See number on the back of artwork if available

Year created

What services are you interested in?

Please mail me a certificate of authencity of the artwork listed above.

I would like some information on the artwork and techique used.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Please add an address for your Certificate to be mailed to or if you would prefer a digital version via email please indicate in the message box below.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Message

Any further comments

THANK YOUfor your adding a piece of my art to your collection

THANK YOU
for your adding a piece of my art to your collection