Private Purchase Order Form ( Art ).

Date: __________________________________

First Name: _____________________ Last Name: _________________________________________

Address: _______________________________________________  City :______________________

State / Province: _______________  Zip / Post Code: ____________  Country: _____________________

Phone No : ( ____ ) ______________________ Fax No : ( _____ ) _____________________________

E-mail : __________________________________________ Other : ____________________________

Art description or Numbers: _____________________________________________________________

__________________________________________________________________________________

Total Number of Images: ____________ Total Amount: $_________ in US.   Prepaid shipment: $_________

The amount must be approved with sales or operations (enter the approval code) : _____________________ 

Your Method of Payment:               No COD's. 

Type of Credit Card : __________ Holder's full name : _________________________________________

Card number : _____________________________________________  Exp. date : ________________

Western Union - Money transfer control number: _______________________________________________ 

Money Order by :______________________________________________________________________ 

Entry details: _________________________________________________________________________

For personal use only: 

I understand that the images are copyright protected, and without FPINS.,  FEI., or artist's  
written permission cannot be used for publishing or commercial usage. 

 __________________________________    _____________________     _____________________
Signature                                                           Date:                                       In:      

Fill out the order form with all details, signed and e-mail to: FEI - Art
To confirm your shipment or order call: (705) 745-5770