City*        State*

Zip Code*   

Day Phone (include area code)*

Evening Phone (with area code)*

email address*

Information about your customized Sticks piece
Be sure you have registered as a "friend" of the Ruth Conklin Gallery and have logged in (column to the left) to see the description and price of the item you are considering.
click here to sign-up 

Name of piece*

Number         Size

Theme information

Please describe the theme you have in mind as fully as possible. You can use another Sticks piece to describe the theme. (give name and number of the piece) and you can also use Sticks Themes for ideas (click here)

Special theme information
 

If you have phtotos please send them by e-mail to info@ruthconklingalley.com,
be sure to identify them with your order and name.

Words you would like to use

List words or phrases you would like to use on your cusomized piece.
Be sure to list them in order of importance to you,#1 being of higest importance.
If you would like some suggestions click here for a list.

Word List
 

(Please note:  that if customers words run out, the designers have discretion
to use words of their choice to fit the theme of the custom piece)

Colors you would like to have used

You can use another Sticks piece to describe the colors, be sure to give name and number of the piece. You can also use Sticks Pallets as a guide   (click here)

Colors       
 

Are there any colors you do not want used? 
       

Stain to use (if applicable)
Another Sticks piece to use as a guide (name and number of piece)
      

   Choose stain from this list: Black Rubbed Black Oak Birch Birch with spot Walnut blank
        
        
Any other information you would like us to have with your order?

 

Thank you for your order.
This form will be recieved by the Ruth Conklin Gallery and they will contact you about the order and payment.