Artist________________________________________________

Address:_____________________________________________

Gallery:_______________________________________________

Address:______________________________________________

Title of Work:__________________________________________

Medium______________________________________________

Dimensions:____________________________________________

Specific Materials Used in Execution of Piece (Brand name and type of paint, paper type, fiber content, specific metals, etc.):

Specific Materials Used in the Presentation of Piece (Composition of base or backing, framing, matboard, protective covering, hanging rods, base, etc.):

Recommendations and Cautions Regarding Maintenance and Care of Work (Cleaning, avoiding exposure to direct sun, exposure to dampness, fragility factor, instructions for assembling, etc.):

Gallery agrees to deliver a copy of this Statement to Purchaser of artwork named above.

Date:___________________

Artist's Signature:_________________________

Gallery's Signature:_________________________