Use this form if making a Heritage Giclee® print order. You may print the form and send with your materials.

3925 Deep Rock Road, Richmond, VA 23233 TEL: 804-747-8271 - FAX 804-747-8322 Toll Free: 1-800-260-1948

Contact Name: __________________________________________________________
Company:______________________________________________________________
Address:_______________________________________________________________
City:__________________________________________ State:_______ Zip:_________
Country:_______________________________________________________________
Telephone:____________________________ Alternate Phone:____________________
Email:________________________________ Fax:_____________________________
Resale#_____________________________ (if applicable)  

Title of Artwork:________________________________________________________
Submitted as: ___Original Artwork ___ Digital File___4"x5" transparency, ___8" x 10" transparency,
Indicate paper type or canvas:______________________________________________
Final image dimensions desired:_____________________________________________
Margins for paper:_______________________________________________________
Margins for canvas:__________________________/(color)______________________
Stretcher bar depth:(5/8" standard)_____ /(1.5" museum wrap)______
Print Quantity:__________________________________________________________
Remove Signature:   Y__     N__
Special Instructions:______________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Payment Terms:
Payment in full must be received with your order. We accept Visa, MasterCard, AMEX, Discover personal checks and money
orders. We ship most proofs via USPS first class. Finished work is usually shipped via FedEx.

Make all checks payable to: Staples Fine Art or provide credit card information below.
__Visa __MasterCard #__AMEX#__________________________________ Expiration____________
Card Holders Name:_________________________________________________________________

Limits of Liability:
Submission of any materials such as film, photos, digital files or original artwork to Staples Fine Art constitutes
an agreement by the client that any damage or loss incurred will only entitle the client to replacement with a like
amount of raw materials, unexposed film, or digital media. Except for said replacement, our acceptance of the
artists images and materials is without warranty or liability.

_______________________________________ _______________
Artists Signature & Date: (required)

___________________________________

1. Include your name, mailing & shipping address, phone numbers and email address if available.
2. Send your original artwork or a film transparency (4”x5” or 8”x10”) or send a digital file on a CD
     or upload via our FTP site. When sending transparencies of your artwork please remember that
     we will color match to the transparency and if it does not look like the original your print will  
     also not look like the original. Examine each transparency carefully before sending them to us.
3. A reference name or number for each image.
4. Media type (Paper, Canvas or Other).
5. Size of desired images.
6. Margin (white space) around the prints.
7. Number of finished sheets. (if ordering more than what is included in the setup fee.
8. Payment information. We accept Visa, MasterCard & American Express, Discover, and Checks.

The following sample layouts may be helpful in planning the number of prints per sheet.
This example shows layouts on a master sheet size of 34” x 44”.
Grey area is the actual image size and assumes a 1” border.