Print and fill in this page and post it to us or email the following details to tom@tomkemp.com:

I would like to receive a signed, numbered print of the screen-printed Analysis poster by Tom Kemp at 50 pounds, including postage and packing.

Number of posters required_______

Name_____________________________________________________

Address___________________________________________________

_________________________________________________________

_________________________________________________________

Email_____________________________________________________

Payment Method (please tick one)

______I enclose a sterling cheque for 50 pounds for each poster required, made payable to 'Twice Publishing' OR

______please invoice me (institutional purchase order required) OR

______my credit card details are (Mastercard or Visa only):

Name on card____________________________________________

Card number______________________________________________

Expiry date______________________________________________

Signature________________________________________________

Either post this form to

Twice Publishing, 53 Mill Street, Oxford OX2 0AL, UK

or email the above information to tom@tomkemp.com