---------------------- Order Form ----------------------

Customer Information:
Name:________________________________________________________
Email Address:_______________________________________________
Delivery Address:____________________________________________
                 ____________________________________________
Phone (including Area Code):_________________________________

ArchImage Order Information:
Check one:  Archetype__  Deity__  Personal Spiritual Guide__
Gender:  Male__  Female__
Traditional Tribal/Ethnic Origin:____________________________

Name/Spiritual Theme: (Use this space to disclose the name of
your deity, or the spiritual theme of your Spirit Guide or
archetype so that a representative may research and personify
your ArchImage as effectively as possible:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Hair Color:  Black__ Brown__ Blond__ Red__ Gray__ White__
             Other________________
Skin Finish: Natural (Ethnic) Color__
             Or Stone Finish: Gry__ Brn__ Wht__ Blk__ Green__
Symbolism (If possible, attach a picture or sketch, as well
as the name of specified symbols to be used):________________
_____________________________________________________________
_____________________________________________________________

Ceremonial Paint:
Do you wish to have symbols painted on the face? Yes__ No__
Color Themes (For painted symbols, beads, etc.):_____________
_____________________________________________________________

*Customization Options:
(Please be as specific as possible. i.e.: type, color, shape,
etc.)
Stones_______________________________________________________
Beads________________________________________________________
Metals_______________________________________________________
Leather/Fur__________________________________________________
Feathers (Legal Feathers only)_______________________________
Seashells/Bones______________________________________________
Flowers/Leaves_______________________________________________
Talisman_____________________________________________________
Medicine Pouch_______________________________________________
Other________________________________________________________
_____________________________________________________________

* Appropriate charges will be added for some customization
details.

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