Request FormFor a painting or print, following donation to Children’s Hospices across Scotland Name * I confirm that I have made a donation to Children's Hospices Across Scotland, and forwarded their thank you email to info@ArtbyLC.com First Name Last Name Email * Phone * (###) ### #### Title of chosen painting or print * Option choice * State your chosen option, or size, or add 'none' if there is no choice Address * Add address you would like the painting or print sent to Address 1 Address 2 City State/Province Zip/Postal Code Country After clicking 'Submit' you will receive an email within 24 hours confirming your purchase Thank you! Your donation and request will be acknowledged shortly.