Custom Order Form

Thank you for your interest in Xray Artistry. Please use this form to start the process of creating your custom piece. After your information is submitted, Susan Summerton or one of her artists will contact you to ensure that we create a design you will be happy with. We will send you an image of your custom piece for your approval before your art is printed.
 
* Below indicates a required field
Customer Information
 
Name *

Phone

Email *

Confirm Email *

Shipping Address

Billing Address

How did you learn about Xray Artistry?


Order Information
 
Canvas
Please Select Options:

Lightbox
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Print
Please Select Options:

 
Custom Text

Text Color: Color Black & White
Text Border Color:
Additional Details
Please provide any information that you think will help us personalize your piece such as including the profession, degree and/or specialty of the person who the art is being created for so that we can choose the best letters for your piece.

Shipping Method
Standard (4-6 weeks)
Rush  (Date requested by:  )