Request a Commission from Lan Medina

If you would like to request a commission, please fill out the form below. ALL FIELDS ARE REQUIRED.

Name:
Street Address:
City:
State:
Zip/Postal Code:
Phone:
Email Address:
Quantity:
 
Commission Description/Additional Comments:
If outside the US, please enter full International shipping address here.
  Check/Money Order
Credit or Debit Card (through PayPal, 3-4% will be added on your invoice to cover PayPal fees)

 

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