Helene Portrait Request

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Original Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Can you provide a photo of the lost home? (No worries if not - Google Earth is an amazing thing!)

Are there any key elements you would like included in your portrait? (Think places of high emotional importance - swings, special chairs, trees, etc.)

What type of home portrait are you interested in?

Other

Are you comfortable with images of your home being shown in an online portfolio and/or social media?

Thank you for taking the time to complete this form! I will reach out within the week to follow up with you about the details of your portrait. If you chose a wooden portrait, I will coordinate with you about getting the wood. (I have plenty of my own, but if you would like wood from your own home, I will get it from you!)

Please be patient with me while I complete your portrait. Depending on interest, it could take me quite a while. Trust the the investment in time will give you a piece that was truly created with love.

I'm so terribly sorry for your loss, and I hope that this small offering can bring you some peace.

With love,

Lauren