Medefiziks Agreement Form

Medifiziks CLIENT AGREEMENT FORM
Client Name*

First NameLast Name
Email*
example@example.com
Delivery Address *

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Have you viewed Medifiziks portfolio?*
The portfolio will give you an idea of what want in your commission before submitting this agreement form.
How did you hear about Medefiziks?*

FacebookInstagramOther
When would you like to start the commission?*
May take up to 2-3 weeks to complete commission. There will NOT be any additional costs if commission is completed earlier than expected.
Please choose one*

Pickup orderDeliver order
Estimated Date for pickup/delivery*

MonthDayYear
Date
Estimated Time for pickup/delivery*

Hour Minutes

AM/PM Option
What are you looking for in the commission? (Describe in full detail)*
An email will be sent if you are NOT specific. You can also send an email of an image to medefiziksartwork@gmail.com if the artwork is too complicated to describe.
Do you wish to keep in contact through email for periodic updates of your commission?

My Products

Credit or Debit Card
NO CASH PAYMENTS WILL BE ACCEPTED IF AGREEMENT FORM IS COMPLETED ONLINE. CARD ONLY.
Remaining Half payment details*
Payment details for when the artwork is picked up or delivered. Venmo and Cashapp are also acceptable, @medefiziks
Would you like a certificate of authenticity?*
I,First Name* Last Name* will be the one responsible for the purchase and handling of this art commission. I will be the only one receiving this physical artwork. Signing this agreement form confirms that I will pay 50% of the commission fee before the artwork begins and I will pay the remaining cost upon delivery/pickup. I understand that if I do not pay the remaining cost I will not receive the painting and will not be issued a refund.
Signature of client*

Clear
First and Last Name
Signature of artist

Clear
Should be Empty:

Medifiziks CLIENT AGREEMENT FORM